Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | J5328 | TX |
NPI | 1033144209 |
---|---|
Provider Name | Jaime Gateno |
First Address | Houston, TX 77030-2753 |
Second Address | Houston, TX 77030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 04/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126772607 | (05) | TX |
126772608 | (05) | TX |
8S5700 | BLUE CROSS BLUE SHIELD (01) | TX |
F74693 | (02) | TX |