Provider Demographics
NPI:1225179823
Name:GAETA, RAYMOND R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:R
Last Name:GAETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 OFARRELL ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1386
Mailing Address - Country:US
Mailing Address - Phone:650-645-1100
Mailing Address - Fax:
Practice Address - Street 1:1900 OFARRELL ST
Practice Address - Street 2:STE 100
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1386
Practice Address - Country:US
Practice Address - Phone:650-645-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60351207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G603510Medicaid
CA00G603510Medicaid
CA00G603510Medicaid