MEDICARE: GAY AUREA PIMENTEL CALUYA DPT

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	225100000X	Physical Therapist	26141	CA

General Provider Information

NPI Number	:	1568511129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAY AUREA PIMENTEL CALUYA DPT

Provider Business Mailing Address
First Line	:	761 KATYDID CT
Second Line	:	MARTINEZ
City	:	MARTINEZ
State	:	CA
Zip	:	94553-2221
Country	:	US
Telephone Number	:	510-375-3626
Fax Number	:

Provider Business Practice Location Address
First Line	:	761 KATYDID CT
Second Line	:	MARTINEZ
City	:	MARTINEZ
State	:	CA
Zip	:	94553-2221
Country	:	US
Telephone Number	:	510-375-3626
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	12/31/2015

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