Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 1588 | TX |
NPI | 1467860015 |
---|---|
Provider Name | Edwardo Gaitan |
First Address | Mcallen, TX 78503-1228 |
Second Address | Mcallen, TX 78503-1228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2014 |
Last Update Date | 28/07/2014 |