Provider Demographics
NPI:1053649129
Name:KLEBANOFF, GINA NEGRI (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:NEGRI
Last Name:KLEBANOFF
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2806
Mailing Address - Country:US
Mailing Address - Phone:949-280-6676
Mailing Address - Fax:
Practice Address - Street 1:964 MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2806
Practice Address - Country:US
Practice Address - Phone:949-280-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13274171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist