Provider Demographics
NPI:1265768162
Name:RONDINELLI, GINA L (PHD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:L
Last Name:RONDINELLI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CHIANTI
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1402
Mailing Address - Country:US
Mailing Address - Phone:714-742-2424
Mailing Address - Fax:
Practice Address - Street 1:19742 MACARTHUR BLVD STE 125
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2430
Practice Address - Country:US
Practice Address - Phone:714-742-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21677103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical