Provider Demographics
NPI:1861509929
Name:TRAJE-QUITORIANO, GLORIA GONZALES (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:GONZALES
Last Name:TRAJE-QUITORIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 TUOLUMNE ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1227
Mailing Address - Country:US
Mailing Address - Phone:559-442-0111
Mailing Address - Fax:559-442-4822
Practice Address - Street 1:2640 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1227
Practice Address - Country:US
Practice Address - Phone:559-442-0111
Practice Address - Fax:559-442-4822
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42040208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42040Medicaid
CAF64659Medicare UPIN