Basic Information
| Provider Information | |||||||||
| NPI: | 1609339092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHA | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1559 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933021559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616353050 | ||||||||
| FaxNumber: | 6618691503 | ||||||||
| Practice Location | |||||||||
| Address1: | 7800 NILES STREET | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933064937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613284284 | ||||||||
| FaxNumber: | 6616169977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2019 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | PTL121 | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.