Provider Demographics
NPI:1780417659
Name:SELGA, GINA MARIE
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:SELGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-1524
Mailing Address - Country:US
Mailing Address - Phone:575-640-1320
Mailing Address - Fax:
Practice Address - Street 1:2013 BRIARWOOD LN
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1524
Practice Address - Country:US
Practice Address - Phone:575-640-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No374700000XNursing Service Related ProvidersTechnician