Basic Information
| Provider Information | |||||||||
| NPI: | 1003154428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAETANO | ||||||||
| FirstName: | NEERU | ||||||||
| MiddleName: | KAUR | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13768 ROSWELL AVE | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917101401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095901200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13768 ROSWELL AVE | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917101401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095901200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2013 | ||||||||
| LastUpdateDate: | 01/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA14815 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.