Provider Demographics
NPI:1467860015
Name:GAITAN, EDWARDO
Entity Type:Individual
Prefix:
First Name:EDWARDO
Middle Name:
Last Name:GAITAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S 1ST ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1228
Mailing Address - Country:US
Mailing Address - Phone:956-682-4409
Mailing Address - Fax:
Practice Address - Street 1:1901 S 1ST ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1228
Practice Address - Country:US
Practice Address - Phone:956-682-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1588224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist