Provider Demographics
NPI:1427036284
Name:SUGINO, GERALD (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:SUGINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26732 CROWN VALLEY PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6337
Mailing Address - Country:US
Mailing Address - Phone:949-365-2444
Mailing Address - Fax:949-365-2356
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 170
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6337
Practice Address - Country:US
Practice Address - Phone:949-365-2444
Practice Address - Fax:949-365-2356
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G509770Medicaid
CAWG50977FMedicare PIN
CA00G509770Medicaid
CAGW343ZMedicare PIN