Provider Demographics
NPI:1942967138
Name:GHATTAS, GINA WAEL (LMT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:WAEL
Last Name:GHATTAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9033 BASELINE RD STE N
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1215
Mailing Address - Country:US
Mailing Address - Phone:909-296-5105
Mailing Address - Fax:
Practice Address - Street 1:9033 BASELINE RD STE N
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1215
Practice Address - Country:US
Practice Address - Phone:909-296-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist