Healthcare Provider Details

I. General information

NPI: 1255262242
Provider Name (Legal Business Name): GINO NICOLAS ASINAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 ARTESIA BLVD STE A
ARTESIA CA
90703-2547
US

IV. Provider business mailing address

1170 E ALOSTA AVE UNIT 19
AZUSA CA
91702-2797
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-1733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-ZYTDNU
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: