Provider Demographics
NPI:1184146243
Name:SOBRETODO, GINA (FNP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:SOBRETODO
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 TERRABELLA WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-3168
Mailing Address - Country:US
Mailing Address - Phone:626-893-7120
Mailing Address - Fax:
Practice Address - Street 1:300 CONTINENTAL BLVD STE 635
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5040
Practice Address - Country:US
Practice Address - Phone:562-335-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA801746163W00000X
CA95007697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse