Healthcare Provider Details

I. General information

NPI: 1154124311
Provider Name (Legal Business Name): ALEXANDRA GAYTAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 N 6TH ST UNIT B
SANTA PAULA CA
93060-2004
US

IV. Provider business mailing address

216 N 6TH ST UNIT B
SANTA PAULA CA
93060-2004
US

V. Phone/Fax

Practice location:
  • Phone: 820-777-9740
  • Fax: 820-777-9740
Mailing address:
  • Phone: 820-777-9740
  • Fax: 820-777-9740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: