Provider Demographics
NPI:1194837427
Name:GATELY, AL P
Entity type:Individual
Prefix:MR
First Name:AL
Middle Name:P
Last Name:GATELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 FARMLAND DR
Mailing Address - Street 2:
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427-9314
Mailing Address - Country:US
Mailing Address - Phone:805-886-8062
Mailing Address - Fax:
Practice Address - Street 1:300 N SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1316
Practice Address - Country:US
Practice Address - Phone:805-681-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH0607994OtherDRIVERS LICENSE