Provider Demographics
NPI:1447744628
Name:SUNIE-LOPEZ, GINA MARIE (PPS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:SUNIE-LOPEZ
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 STEWART AVE RM 17
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-3519
Mailing Address - Country:US
Mailing Address - Phone:650-834-4923
Mailing Address - Fax:
Practice Address - Street 1:700 STEWART AVE RM 17
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-3519
Practice Address - Country:US
Practice Address - Phone:650-834-4923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool