MEDICARE: GUSTAVO NINO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC21763	CA
2	111NS0005X	Sports Physician Chiropractor	DC21763	CA

General Provider Information

NPI Number	:	1568685915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO NINO D.C.

Provider Business Mailing Address
First Line	:	41 N GARFIELD AVE
Second Line	:	SUITE 101A
City	:	ALHAMBRA
State	:	CA
Zip	:	91801-3556
Country	:	US
Telephone Number	:	626-458-2339
Fax Number	:	626-458-1429

Provider Business Practice Location Address
First Line	:	41 N GARFIELD AVE
Second Line	:	SUITE 101A
City	:	ALHAMBRA
State	:	CA
Zip	:	91801-3556
Country	:	US
Telephone Number	:	626-458-2339
Fax Number	:	626-458-1429

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	09/11/2025

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Directions to “ GUSTAVO NINO D.C.” Practice Location

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