Provider Demographics
NPI:1770566168
Name:LA TULIPE, GINA M (PT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:LA TULIPE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:ALFISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2000 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5313
Mailing Address - Country:US
Mailing Address - Phone:831-375-1885
Mailing Address - Fax:831-375-7436
Practice Address - Street 1:350 BOLLINGER CANYON LN
Practice Address - Street 2:STE A
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4592
Practice Address - Country:US
Practice Address - Phone:925-735-6414
Practice Address - Fax:925-735-6450
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 23994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAR316ZMedicare PIN
CAAW492ZMedicare PIN