Provider Demographics
NPI:1265260467
Name:ALCAIDA, GINA M
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:ALCAIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:BATUNGBACAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:609 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:OK
Mailing Address - Zip Code:74825-8164
Mailing Address - Country:US
Mailing Address - Phone:580-344-4847
Mailing Address - Fax:
Practice Address - Street 1:901 W 18TH ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-7423
Practice Address - Country:US
Practice Address - Phone:580-436-6130
Practice Address - Fax:580-436-6135
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty