Provider Demographics
NPI:1851403075
Name:HARTLAND, GARY A (PA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:HARTLAND
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 EDITH AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3043
Mailing Address - Country:US
Mailing Address - Phone:530-395-0340
Mailing Address - Fax:530-255-6107
Practice Address - Street 1:2662 EDITH AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0000
Practice Address - Country:US
Practice Address - Phone:530-395-0340
Practice Address - Fax:530-255-6107
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13653207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851403075Medicaid
CAOPA136530Medicare ID - Type Unspecified
CAS18094Medicare UPIN
CA0PA136530Medicare PIN
S18094Medicare UPIN