Provider Demographics
NPI:1578442745
Name:GAMINO, JULIAN ALEXANDER
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:ALEXANDER
Last Name:GAMINO
Suffix:
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 1:11949 CENTRALIA ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1435
Mailing Address - Country:US
Mailing Address - Phone:562-841-0572
Mailing Address - Fax:
Practice Address - Street 1:13210 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4510
Practice Address - Country:US
Practice Address - Phone:562-841-0572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-30
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA741992164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse