MEDICARE: MARK HIDALGO GABOT C.R.N.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	3544	CA

General Provider Information

NPI Number	:	1174704324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK HIDALGO GABOT C.R.N.A

Provider Business Mailing Address
First Line	:	9161 SIERRA AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92335-4729
Country	:	US
Telephone Number	:	909-427-7162
Fax Number	:

Provider Business Practice Location Address
First Line	:	9161 SIERRA AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92335-4729
Country	:	US
Telephone Number	:	909-427-7162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	12/01/2021

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