Provider Demographics
NPI:1144755414
Name:GAITAN, CAMILA V
Entity Type:Individual
Prefix:
First Name:CAMILA
Middle Name:V
Last Name:GAITAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 98TH PL
Mailing Address - Street 2:APT LB
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3001
Mailing Address - Country:US
Mailing Address - Phone:718-271-3687
Mailing Address - Fax:
Practice Address - Street 1:5530 98TH PL
Practice Address - Street 2:APT LB
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3001
Practice Address - Country:US
Practice Address - Phone:718-271-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator