Individual
EMMANUEL DE JESUS GAETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 ILLINI DR, PEORIA, IL 61605-2576
(909) 677-8728
Mailing address
1 ILLINI DR, PEORIA, IL 61605-2576
(909) 677-8728
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/27/2024
Last updated
03/27/2024
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