Provider Demographics
NPI:1881602175
Name:GABBITA, GEETHA V (MD)
Entity type:Individual
Prefix:
First Name:GEETHA
Middle Name:V
Last Name:GABBITA
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 1:14568 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2129
Mailing Address - Country:US
Mailing Address - Phone:562-698-8263
Mailing Address - Fax:562-698-1001
Practice Address - Street 1:14568 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2129
Practice Address - Country:US
Practice Address - Phone:562-698-8263
Practice Address - Fax:562-698-1001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43392208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A433920Medicaid
CAA43392Medicare ID - Type Unspecified
CA00A433920Medicaid