Provider Demographics
NPI:1124166467
Name:BACCARI, GINA MARIE (CCP,SA-C,LSA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:BACCARI
Suffix:
Gender:F
Credentials:CCP,SA-C,LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6742 MANOR HL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1107
Mailing Address - Country:US
Mailing Address - Phone:210-698-9573
Mailing Address - Fax:
Practice Address - Street 1:3463 MAGIC DR
Practice Address - Street 2:SUITE T21
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2973
Practice Address - Country:US
Practice Address - Phone:210-614-8101
Practice Address - Fax:210-614-8102
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00526246ZC0007X
TXFPF00000207242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist