Healthcare Provider Details

I. General information

NPI: 1770566168
Provider Name (Legal Business Name): GINA M LA TULIPE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA M ALFISI P.T.

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BOLLINGER CANYON LN STE A
SAN RAMON CA
94582-4592
US

IV. Provider business mailing address

2000 GARDEN RD
MONTEREY CA
93940-5313
US

V. Phone/Fax

Practice location:
  • Phone: 925-735-6414
  • Fax: 925-735-6450
Mailing address:
  • Phone: 831-375-1885
  • Fax: 831-375-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 23994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: