Healthcare Provider Details

I. General information

NPI: 1912404567
Provider Name (Legal Business Name): GINA BAAKLINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 01/02/2024
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
COLORADO SPRINGS CO
80913-4613
US

IV. Provider business mailing address

1650 COCHRANE CIR
COLORADO SPRINGS CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7000
  • Fax:
Mailing address:
  • Phone: 719-526-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101267939
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101267939
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberDR.0071860
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: