Provider Demographics
NPI:1114996055
Name:CEKADA, GAYLE S (MD)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:S
Last Name:CEKADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 CASA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1804
Mailing Address - Country:US
Mailing Address - Phone:805-903-1391
Mailing Address - Fax:805-785-0367
Practice Address - Street 1:184 CASA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1804
Practice Address - Country:US
Practice Address - Phone:805-903-1391
Practice Address - Fax:805-785-0367
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA62340OtherBLUE CROSS
CA00A623400OtherBLUE SHIELD OF CALIFORNIA
CA00A062340Medicaid
CAA62340OtherBLUE CROSS
CAG53676Medicare UPIN
CAEW118ZMedicare PIN