Healthcare Provider Details

I. General information

NPI: 1124136734
Provider Name (Legal Business Name): JOHN GREGORY GAITAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 HITCHCOCK WAY
SANTA BARBARA CA
93105-3101
US

IV. Provider business mailing address

PO BOX 62106
SANTA BARBARA CA
93160-2106
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-6211
  • Fax: 805-563-6220
Mailing address:
  • Phone: 805-681-1761
  • Fax: 805-681-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG74787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: