Provider Demographics
NPI:1821149600
Name:SUGGETT, GINA M (MA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:SUGGETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:CONCEPCION-SUGGETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:13223 BLACK MOUNTAIN RD # 1358
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2698
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13223 BLACK MOUNTAIN RD # 1358
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2698
Practice Address - Country:US
Practice Address - Phone:619-208-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10720235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist