Provider Demographics
NPI:1659009934
Name:TRELLO, GINAMARIA (CMT)
Entity Type:Individual
Prefix:MRS
First Name:GINAMARIA
Middle Name:
Last Name:TRELLO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WOODLAND AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2643
Mailing Address - Country:US
Mailing Address - Phone:646-591-7121
Mailing Address - Fax:
Practice Address - Street 1:411 SAN ANSELMO AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2663
Practice Address - Country:US
Practice Address - Phone:415-464-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72220225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist