Provider Demographics
NPI:1134735533
Name:GATAN, VICENTE FERNANDO III (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:VICENTE
Middle Name:FERNANDO
Last Name:GATAN
Suffix:III
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10042 MERRY BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-7211
Mailing Address - Country:US
Mailing Address - Phone:619-517-6205
Mailing Address - Fax:
Practice Address - Street 1:10042 MERRY BROOK TRL
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-7211
Practice Address - Country:US
Practice Address - Phone:619-517-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily