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General NPI Number Information
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NPI Number | 1346964210
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Entity Type | Individual
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Provider Name | RHEANNE MADISON GATMAITAN DMD
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 8678 19TH ST
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-4559
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Country | US
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Telephone | 909-257-3388
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Fax |
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Provider Business Mailing Address
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Address Line | 501 E DEL MAR BLVD APT 306
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City | PASADENA
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State | CA
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Zip | 91101-3613
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Country | US
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Telephone | 484-557-1028
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 108163
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License Number State | CA
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