Active NPI
Greg Gastaldo, M.D.
- Clinic/Center
- San Diego, CA
National Provider Identifier
1114102241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- License
- G58872
- Practice address
- 5500 Campanile Dr
San Diego, CA 92182-0001 - Phone
- (619) 594-2866
- Fax
- (619) 594-5613
- NPI assigned
- Jan 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | G58872 | CA | Primary |
Addresses
Primary practice location
5500 Campanile Dr
San Diego, CA 92182-0001
Mailing address
5500 Campanile Dr
San Diego, CA 92182-0001
Phone (619) 594-2866
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G588720 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G58872 | CA | MD | Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199750400000",
"number": "1114102241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5500 CAMPANILE DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921820001",
"telephone_number": "619-594-2866",
"fax_number": "619-594-5613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5500 CAMPANILE DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921820001",
"telephone_number": "619-594-2866",
"fax_number": "619-594-5613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GASTALDO",
"first_name": "GREG",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-08",
"last_updated": "2008-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "CA",
"license": "G58872",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G588720",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.