Provider Demographics
NPI:1144233610
Name:DECLEVE, GAEL F (DO)
Entity Type:Individual
Prefix:MR
First Name:GAEL
Middle Name:F
Last Name:DECLEVE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1595 SOQUEL DR STE 330
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1722
Mailing Address - Country:US
Mailing Address - Phone:831-465-7761
Mailing Address - Fax:831-475-1156
Practice Address - Street 1:528 CAPITOLA AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2750
Practice Address - Country:US
Practice Address - Phone:831-475-1630
Practice Address - Fax:831-475-1629
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0028551Medicaid
CAH02882Medicare UPIN
CAGR0028551Medicaid