1366608978 NPI number — DR. JAIME GALANO GABUTEN D.D.S.

Table of content: DR. JAIME GALANO GABUTEN D.D.S. (NPI 1366608978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366608978 NPI number — DR. JAIME GALANO GABUTEN D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GABUTEN
Provider First Name:
JAIME
Provider Middle Name:
GALANO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GABUTEN
Provider Other First Name:
JAIME
Provider Other Middle Name:
VALENTINO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366608978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4917 LINCOLN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CYPRESS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90630-2655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-826-4250
Provider Business Mailing Address Fax Number:
714-826-4083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4917 LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90630-2655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-826-4250
Provider Business Practice Location Address Fax Number:
714-826-4083
Provider Enumeration Date:
08/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  50749 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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