Provider Demographics
NPI:1891818282
Name:PAPA, GINA ANN (MAP, MFT)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:ANN
Last Name:PAPA
Suffix:
Gender:F
Credentials:MAP, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 VILLAGE GRN
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5205
Mailing Address - Country:US
Mailing Address - Phone:310-720-8860
Mailing Address - Fax:
Practice Address - Street 1:241 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2717
Practice Address - Country:US
Practice Address - Phone:310-720-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0MFCC000OtherBLUE SHIELD OF CA
CAPAPAGINAOtherCORPHEALTH, INC.