Provider Demographics
NPI:1053772459
Name:GAITAN, VICTOR HUGO
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:HUGO
Last Name:GAITAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 OCTAVIA ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1159
Mailing Address - Country:US
Mailing Address - Phone:510-326-4917
Mailing Address - Fax:
Practice Address - Street 1:2815 OCTAVIA ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1159
Practice Address - Country:US
Practice Address - Phone:510-326-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker