Provider Demographics
NPI:1689001299
Name:DELGADO, GINA JO (ATC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:JO
Last Name:DELGADO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:JO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:4533 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4122
Mailing Address - Country:US
Mailing Address - Phone:818-980-7280
Mailing Address - Fax:
Practice Address - Street 1:4533 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-4122
Practice Address - Country:US
Practice Address - Phone:818-980-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0205021832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer