Provider Demographics
NPI:1528554839
Name:GUGLIELMONI, GINA MARIE (ATC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:GUGLIELMONI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SOUTHCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3023
Mailing Address - Country:US
Mailing Address - Phone:415-509-3784
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95192-1000
Practice Address - Country:US
Practice Address - Phone:415-509-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000336042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer