Provider Demographics
NPI:1073335311
Name:GIMINO, ROGELIO JABINES JR
Entity type:Individual
Prefix:MR
First Name:ROGELIO
Middle Name:JABINES
Last Name:GIMINO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15203 LORNE ST
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4416
Mailing Address - Country:US
Mailing Address - Phone:747-842-9766
Mailing Address - Fax:
Practice Address - Street 1:8550 BALBOA BLVD STE 242
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3593
Practice Address - Country:US
Practice Address - Phone:818-894-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53545225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant