Provider Demographics
NPI:1326046855
Name:MANSY, GINA J (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:J
Last Name:MANSY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:JABRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:959 LANE AVE
Mailing Address - Street 2:UCSD RADIATION ONCOLOGY SOUTH BAY
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4528
Mailing Address - Country:US
Mailing Address - Phone:619-502-7730
Mailing Address - Fax:619-502-7740
Practice Address - Street 1:959 LANE AVE
Practice Address - Street 2:UCSD RADIATION ONCOLOGY SOUTH BAY
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4528
Practice Address - Country:US
Practice Address - Phone:619-502-7730
Practice Address - Fax:619-502-7740
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA650212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA65021OtherSTATE LICENSE
CA00A650210Medicaid
CAWA65021IMedicare PIN
CAA65021OtherSTATE LICENSE
CAWA65021Medicare ID - Type Unspecified
CAWA65021EMedicare PIN
CAWA65021DMedicare PIN
CA00A650210Medicaid
CAWA65021HMedicare PIN