Provider Demographics
NPI:1124323464
Name:CLOUTIER, GINA MARASIGAN
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARASIGAN
Last Name:CLOUTIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 E WILSON AVE.
Mailing Address - Street 2:STE 400
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:512 E. WILSON AVE.
Practice Address - Street 2:STE 400
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4351
Practice Address - Country:US
Practice Address - Phone:818-507-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN247433164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse