Provider Demographics
NPI:1376244434
Name:GANO, KHATRINA
Entity Type:Individual
Prefix:
First Name:KHATRINA
Middle Name:
Last Name:GANO
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 1:1320 W HILLSDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3125
Mailing Address - Country:US
Mailing Address - Phone:650-570-6094
Mailing Address - Fax:
Practice Address - Street 1:1320 W HILLSDALE BLVD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-3125
Practice Address - Country:US
Practice Address - Phone:650-570-6094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA167334183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician