Provider Demographics
NPI:1124565981
Name:CIFALDI, GINA (MS, RT(R))
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CIFALDI
Suffix:
Gender:F
Credentials:MS, RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1137
Mailing Address - Country:US
Mailing Address - Phone:414-771-9171
Mailing Address - Fax:414-774-2803
Practice Address - Street 1:2626 N 76TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1137
Practice Address - Country:US
Practice Address - Phone:414-771-9171
Practice Address - Fax:414-774-2803
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5360247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist