Provider Demographics
NPI:1700162575
Name:SACAY, GERGETTE LOVE DATAN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:GERGETTE LOVE
Middle Name:DATAN
Last Name:SACAY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:GERGETTE LOVE
Other - Middle Name:CONDINO
Other - Last Name:DATAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:FILE # 54701
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-4701
Mailing Address - Country:US
Mailing Address - Phone:909-558-2870
Mailing Address - Fax:
Practice Address - Street 1:11370 ANDERSON STREET SUITE 3600
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3130
Practice Address - Country:US
Practice Address - Phone:909-558-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21364OtherBOARD OF REGISTERED NURSING