Provider Demographics
NPI:1508901604
Name:GAITAN, RENE JAVIER (BA)
Entity Type:Individual
Prefix:MR
First Name:RENE
Middle Name:JAVIER
Last Name:GAITAN
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CHICON ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-2428
Mailing Address - Country:US
Mailing Address - Phone:512-735-2108
Mailing Address - Fax:
Practice Address - Street 1:2001 CHICON ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-2428
Practice Address - Country:US
Practice Address - Phone:512-735-2108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker