MEDICARE: DR. GINA J MANSY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	A65021	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A65021	OTHER	CA	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326046855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA J MANSY M.D.

Provider Business Mailing Address
First Line	:	959 LANE AVE
Second Line	:	UCSD RADIATION ONCOLOGY SOUTH BAY
City	:	CHULA VISTA
State	:	CA
Zip	:	91914-4528
Country	:	US
Telephone Number	:	619-502-7730
Fax Number	:	619-502-7740

Provider Business Practice Location Address
First Line	:	959 LANE AVE
Second Line	:	UCSD RADIATION ONCOLOGY SOUTH BAY
City	:	CHULA VISTA
State	:	CA
Zip	:	91914-4528
Country	:	US
Telephone Number	:	619-502-7730
Fax Number	:	619-502-7740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	04/18/2012

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