Provider Demographics
NPI:1750679833
Name:BARONIAN-MOORE, GINA MARIE (CMT, CLT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:BARONIAN-MOORE
Suffix:
Gender:F
Credentials:CMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4844 FUNSTON GATE CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4529
Mailing Address - Country:US
Mailing Address - Phone:925-202-8230
Mailing Address - Fax:
Practice Address - Street 1:1601 RAILROAD AVE STE F
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-3106
Practice Address - Country:US
Practice Address - Phone:925-202-8230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22264225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist