Healthcare Provider Details

I. General information

NPI: 1164654422
Provider Name (Legal Business Name): MAURICIO DIGENES GAYTAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MAURICE DIOGENES GAYTAN M.D, FAAP

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N ACACIA AVE
REEDLEY CA
93654-2102
US

IV. Provider business mailing address

1433 N ACACIA AVE
REEDLEY CA
93654-2102
US

V. Phone/Fax

Practice location:
  • Phone: 559-391-3100
  • Fax: 559-391-3102
Mailing address:
  • Phone: 559-391-3100
  • Fax: 559-391-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG56203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: