Provider Demographics
NPI:1912985979
Name:DUEL, GINA M G (MS PAC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M G
Last Name:DUEL
Suffix:
Gender:F
Credentials:MS PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 W COAST HWY STE 330
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4093
Mailing Address - Country:US
Mailing Address - Phone:949-764-6090
Mailing Address - Fax:949-764-6085
Practice Address - Street 1:3900 W COAST HWY STE 330
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4093
Practice Address - Country:US
Practice Address - Phone:949-764-6090
Practice Address - Fax:949-764-6085
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA53400OtherCA LICENSE
WYQ60028Medicare UPIN
WY122463800Medicaid