Provider Demographics
NPI:1437512829
Name:GORDON-LOPEZ, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GORDON-LOPEZ
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 1:6800 DISTRICT BLVD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-2010
Mailing Address - Country:US
Mailing Address - Phone:661-396-1800
Mailing Address - Fax:661-396-2600
Practice Address - Street 1:6800 DISTRICT BLVD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-2010
Practice Address - Country:US
Practice Address - Phone:661-396-1800
Practice Address - Fax:661-396-2600
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2972103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral