Provider Demographics
NPI:1659531994
Name:GAVINO, ARIEL MONSANTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:MONSANTO
Last Name:GAVINO
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 291307
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-9307
Mailing Address - Country:US
Mailing Address - Phone:480-703-2328
Mailing Address - Fax:
Practice Address - Street 1:1673 W BROADWAY STE 6
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1109
Practice Address - Country:US
Practice Address - Phone:714-774-5915
Practice Address - Fax:714-774-8095
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARCP 18139227800000X
CAPA 15737363AM0700X
CAA 1188222084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical