Healthcare Provider Details

I. General information

NPI: 1699533232
Provider Name (Legal Business Name): GINA HABEEB PHYSICIAN ASSISTANT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 SKYPARK DR STE 210
TORRANCE CA
90505-5388
US

IV. Provider business mailing address

2790 SKYPARK DR STE 210
TORRANCE CA
90505-5388
US

V. Phone/Fax

Practice location:
  • Phone: 310-810-6554
  • Fax: 888-451-3500
Mailing address:
  • Phone: 310-810-6554
  • Fax: 888-451-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GINA HABEEB
Title or Position: PRESIDENT
Credential:
Phone: 310-810-6554