Provider Demographics
NPI:1386667780
Name:GAUTO, ANIBAL RAUL (MD)
Entity Type:Individual
Prefix:
First Name:ANIBAL
Middle Name:RAUL
Last Name:GAUTO
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 1:39300 BOB HOPE DR
Mailing Address - Street 2:BANNAN BLDG 1109
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3203
Mailing Address - Country:US
Mailing Address - Phone:760-834-3790
Mailing Address - Fax:760-834-3791
Practice Address - Street 1:39300 BOB HOPE DR
Practice Address - Street 2:BANNAN BLDG. 1109
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3203
Practice Address - Country:US
Practice Address - Phone:760-834-3790
Practice Address - Fax:760-834-3791
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A367340174400000X
CAA367342086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28167Medicare UPIN
CA00A367340Medicare ID - Type Unspecified