Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT17904 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT 17904 | CA |
NPI | 1023152014 |
---|---|
Provider Name | Mrs. Gina Marie Gualeni |
First Address | San Pedro, CA 90732-3949 |
Second Address | Torrance, CA 90505-2803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W16657 | (02) | CA |
W17904A | (02) | CA |