Provider Demographics
NPI:1700696804
Name:GAYTAN, ROBERT RAYMOND
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:RAYMOND
Last Name:GAYTAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 BLACK ARROW DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7634
Mailing Address - Country:US
Mailing Address - Phone:719-820-0004
Mailing Address - Fax:
Practice Address - Street 1:740 BLACK ARROW DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-7634
Practice Address - Country:US
Practice Address - Phone:719-820-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach