Provider Demographics
NPI:1235191057
Name:PATINO, GABRIEL HERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:HERNANDO
Last Name:PATINO
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:PO BOX 661972
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1972
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:6328 FAIRMOUNT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3664
Practice Address - Country:US
Practice Address - Phone:510-525-7999
Practice Address - Fax:510-588-5459
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA044315207P00000X, 207R00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A443156Medicare PIN
CA00A443159Medicare PIN
CA00A443150Medicare UPIN
CAAP766TMedicare PIN
CABL370YMedicare PIN
CAAP766XMedicare PIN
CAAP7660Medicare PIN