Healthcare Provider Details

I. General information

NPI: 1184146243
Provider Name (Legal Business Name): GINA SOBRETODO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CONTINENTAL BLVD STE 635
EL SEGUNDO CA
90245-5040
US

IV. Provider business mailing address

4207 TERRABELLA WAY
OAKLAND CA
94619-3168
US

V. Phone/Fax

Practice location:
  • Phone: 562-335-2730
  • Fax:
Mailing address:
  • Phone: 626-893-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007697
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number801746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: