Provider Demographics
NPI:1023152014
Name:GUALENI, GINA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:GUALENI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:GUALENI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1307 S WYCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3949
Mailing Address - Country:US
Mailing Address - Phone:310-832-3161
Mailing Address - Fax:310-325-7705
Practice Address - Street 1:2842 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2803
Practice Address - Country:US
Practice Address - Phone:310-325-0800
Practice Address - Fax:310-325-7705
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17904225100000X
CAPT 179042251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16657Medicare UPIN
CAW17904AMedicare UPIN