Provider Demographics
NPI:1992546220
Name:GAETA, ILIANA BRIELLE
Entity type:Individual
Prefix:
First Name:ILIANA
Middle Name:BRIELLE
Last Name:GAETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12125 SW 123RD CT
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-3054
Mailing Address - Country:US
Mailing Address - Phone:971-226-3560
Mailing Address - Fax:
Practice Address - Street 1:12125 SW 123RD CT
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-3054
Practice Address - Country:US
Practice Address - Phone:971-226-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula