Provider Demographics
NPI:1831538651
Name:ZOSIMA B. CARINO-GATEB, M.D., INC.
Entity type:Organization
Organization Name:ZOSIMA B. CARINO-GATEB, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ZOSIMA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARINO-GATEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-775-7763
Mailing Address - Street 1:81833 DOCTOR CARREON BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-0602
Mailing Address - Country:US
Mailing Address - Phone:760-775-7763
Mailing Address - Fax:760-775-9953
Practice Address - Street 1:81833 DOCTOR CARREON BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-0602
Practice Address - Country:US
Practice Address - Phone:760-775-7763
Practice Address - Fax:760-775-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA458572080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10944448OtherCAQH
CA00A458571Medicaid
CA1962770875OtherINDIVIDUAL NPI PCP 2
CA1508842741OtherINDIVIDUAL NPI