Provider Demographics
NPI:1174284202
Name:GAITA, IRENE W (FNP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:W
Last Name:GAITA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 HISTORICAL PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5064
Mailing Address - Country:US
Mailing Address - Phone:209-665-4151
Mailing Address - Fax:209-665-4452
Practice Address - Street 1:1341 HISTORICAL PLAZA WAY
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5064
Practice Address - Country:US
Practice Address - Phone:209-665-4151
Practice Address - Fax:209-665-4452
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95018893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily