Provider Demographics
NPI:1114339942
Name:GADALETA, DOMINICK JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:JOHN
Last Name:GADALETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 EL CAMINO REAL STE 200
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1165
Mailing Address - Country:US
Mailing Address - Phone:650-321-7100
Mailing Address - Fax:
Practice Address - Street 1:1795 EL CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1165
Practice Address - Country:US
Practice Address - Phone:650-321-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA169091207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program