Provider Demographics
NPI:1164654422
Name:GAYTAN, MAURICIO DIGENES (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:DIGENES
Last Name:GAYTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MAURICE
Other - Middle Name:DIOGENES
Other - Last Name:GAYTAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, FAAP
Mailing Address - Street 1:1433 N ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-2102
Mailing Address - Country:US
Mailing Address - Phone:559-391-3100
Mailing Address - Fax:559-391-3102
Practice Address - Street 1:1433 N ACACIA AVE
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-2102
Practice Address - Country:US
Practice Address - Phone:559-391-3100
Practice Address - Fax:559-391-3102
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56203208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics