Provider Demographics
NPI:1013026764
Name:GABATO, MANUEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:B
Last Name:GABATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P.O BOX 36001
Mailing Address - Street 2:2410 FIRE MESA ST
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89036
Mailing Address - Country:US
Mailing Address - Phone:702-636-6320
Mailing Address - Fax:702-636-4020
Practice Address - Street 1:2410 FIRE MESA ST
Practice Address - Street 2:2410 FIRE MESA
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9016
Practice Address - Country:US
Practice Address - Phone:702-636-6320
Practice Address - Fax:702-636-4020
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV5863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVB28818Medicare UPIN