Provider Demographics
NPI:1407805344
Name:CINCO, GERINO (PT)
Entity Type:Individual
Prefix:
First Name:GERINO
Middle Name:
Last Name:CINCO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5190 GOVERNOR DR STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2848
Mailing Address - Country:US
Mailing Address - Phone:858-452-0282
Mailing Address - Fax:858-452-6837
Practice Address - Street 1:10803 VISTA SORRENTO PKWY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2792
Practice Address - Country:US
Practice Address - Phone:858-452-0282
Practice Address - Fax:858-452-6837
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 1533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT15336AMedicare ID - Type Unspecified