Healthcare Provider Details

I. General information

NPI: 1447236914
Provider Name (Legal Business Name): MARY PATRICIA GATES RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 DAY ST
RIVERSIDE CA
92507-0901
US

IV. Provider business mailing address

3660 ARLINGTON AVE
RIVERSIDE CA
92506-3912
US

V. Phone/Fax

Practice location:
  • Phone: 951-697-5438
  • Fax: 951-697-5508
Mailing address:
  • Phone: 951-697-5438
  • Fax: 951-697-5508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNP6592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: