Provider Demographics
NPI:1336252352
Name:CALATAYUD, GRACIELA (MD)
Entity type:Individual
Prefix:MRS
First Name:GRACIELA
Middle Name:
Last Name:CALATAYUD
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 1:982 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-5542
Mailing Address - Country:US
Mailing Address - Phone:626-683-3571
Mailing Address - Fax:
Practice Address - Street 1:3400 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5835
Practice Address - Country:US
Practice Address - Phone:323-589-9384
Practice Address - Fax:323-589-0358
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A431740Medicaid
CA00A431740Medicaid
CAF79531Medicare UPIN