Provider Demographics
NPI:1497754824
Name:GAETE, ENRIQUE (PHARMD, MBA)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:GAETE
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:ENRIQUE
Other - Middle Name:
Other - Last Name:GAETE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4 WATERLOO CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1663
Mailing Address - Country:US
Mailing Address - Phone:760-771-6460
Mailing Address - Fax:760-771-6486
Practice Address - Street 1:4 WATERLOO CT
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1663
Practice Address - Country:US
Practice Address - Phone:760-771-6460
Practice Address - Fax:760-771-6486
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43217183500000X, 1835P1200X
COPHA17041183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy