1811928856 NPI number — GLORIA C. NINO

Table of content: GLORIA C. NINO (NPI 1811928856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811928856 NPI number — GLORIA C. NINO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NINO
Provider First Name:
GLORIA
Provider Middle Name:
C.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811928856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
823 GATEWAY CENTER WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92102-4541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-515-2323
Provider Business Mailing Address Fax Number:
619-906-4564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2319 ISLAND AVENUE
Provider Second Line Business Practice Location Address:
SHERMAN HEIGHTS FAMILY HEALTH CENTER
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-515-2435
Provider Business Practice Location Address Fax Number:
619-233-2621
Provider Enumeration Date:
07/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  NP9112 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: NP9112 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)