Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 2OA-8781 | CA |
NPI | 1538147459 |
---|---|
Provider Name | Gina M Caravaglia |
First Address | Cathedral City, CA 92234-1526 |
Second Address | Cathedral City, CA 92234-6401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200122600A | (05) | OK |