Healthcare Provider Details

I. General information

NPI: 1912820309
Provider Name (Legal Business Name): CRISTIAN CLARET GATICA SP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 SAXON WAY
RIVERBANK CA
95367-9559
US

IV. Provider business mailing address

7041 KOLL CENTER PKWY STE 210
PLEASANTON CA
94566-3189
US

V. Phone/Fax

Practice location:
  • Phone: 209-869-2100
  • Fax:
Mailing address:
  • Phone: 855-828-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: