1952528002 NPI number — DR. GASTON CAGIGAO HERRERA M.D.

Table of content: JULIA ORTEGA RUIZ (NPI 1861122301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952528002 NPI number — DR. GASTON CAGIGAO HERRERA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRERA
Provider First Name:
GASTON
Provider Middle Name:
CAGIGAO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952528002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1061 E. VERNON AVE SUITE# F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-233-9686
Provider Business Mailing Address Fax Number:
323-233-0595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1061 E. VERNON AVE SUITE# F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-233-9686
Provider Business Practice Location Address Fax Number:
323-233-0595
Provider Enumeration Date:
04/19/2007

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: 207R00000X , with the licence number:  A23808 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: A23808 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: A23808 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: A23808 , 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)

  • Identifier: 11568785 . This is a "CAQH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A23808 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A23808L . This is a "HEALTHY FAMILY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A23808MM . This is a "MEDICARE SPECIAL NEEDS PROGRAM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 3034086236 . This is a "HEALTH NET" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A23808S . This is a "HEALTHY KIDS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CARE 1ST . This is a "A23808F4" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A23808Z . This is a "LA CARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".