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General NPI Number Information
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NPI Number | 1174284202
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Entity Type | Individual
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Provider Name | IRENE W GAITA FNP
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Gender | Female
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Dates
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Enumeration Date | 12/30/2021
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 420 W ACACIA ST STE 2
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City | STOCKTON
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State | CA
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Zip | 95203-2441
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Country | US
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Telephone | 209-665-4151
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Fax | 209-665-4452
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Provider Business Mailing Address
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Address Line | 1341 HISTORICAL PLAZA WAY
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City | MANTECA
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State | CA
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Zip | 95336-5064
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Country | US
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Telephone | 209-665-4151
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Fax | 209-665-4452
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 756020
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95018893
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License Number State | CA
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