Provider Demographics
NPI:1316206071
Name:GINA TOBALINA MD INC
Entity Type:Organization
Organization Name:GINA TOBALINA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBALINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-803-2602
Mailing Address - Street 1:2545 EAST BIDWELL ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6443
Mailing Address - Country:US
Mailing Address - Phone:916-803-2602
Mailing Address - Fax:916-509-9653
Practice Address - Street 1:2545 EAST BIDWELL ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6443
Practice Address - Country:US
Practice Address - Phone:916-812-8196
Practice Address - Fax:916-509-9653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty