Provider Demographics
NPI:1225784473
Name:PODESTA, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:PODESTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 N PODESTA LN
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:CA
Mailing Address - Zip Code:95236-9423
Mailing Address - Country:US
Mailing Address - Phone:209-608-7669
Mailing Address - Fax:
Practice Address - Street 1:1334 S HAM LN
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3903
Practice Address - Country:US
Practice Address - Phone:209-334-3825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant