Provider Demographics
NPI:1396484309
Name:RAIGOZA, GINA MARIE (MBA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:RAIGOZA
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:MEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3404 N LECANTO HWY STE D
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3569
Mailing Address - Country:US
Mailing Address - Phone:719-256-0127
Mailing Address - Fax:
Practice Address - Street 1:4 AVIS AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3102
Practice Address - Country:US
Practice Address - Phone:719-256-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty