Provider Demographics
NPI:1225335722
Name:VACCARO, GAETANO (PHD)
Entity type:Individual
Prefix:DR
First Name:GAETANO
Middle Name:
Last Name:VACCARO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2332
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92235-2332
Mailing Address - Country:US
Mailing Address - Phone:323-806-3227
Mailing Address - Fax:
Practice Address - Street 1:33749 SKY BLUE WATER TRL
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-4453
Practice Address - Country:US
Practice Address - Phone:323-806-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26314103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)