Provider Demographics
NPI:1013656206
Name:GARDINER, AMY KATHLENE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHLENE
Last Name:GARDINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 HALLER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-5364
Mailing Address - Country:US
Mailing Address - Phone:619-549-2167
Mailing Address - Fax:
Practice Address - Street 1:2067 HALLER ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-5364
Practice Address - Country:US
Practice Address - Phone:619-549-2167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach