Provider Demographics
NPI:1164697876
Name:CLIETT, GINA (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CLIETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 E TANGERINE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-6218
Mailing Address - Country:US
Mailing Address - Phone:520-605-5664
Mailing Address - Fax:520-605-5665
Practice Address - Street 1:1521 E TANGERINE RD STE 201
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-6218
Practice Address - Country:US
Practice Address - Phone:520-605-5664
Practice Address - Fax:520-605-5665
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45919207VF0040X
CAA102104207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery