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NPI Code Detail

MEDICARE: GINA ALI AMFT

MEDICARE: GINA ALI AMFT
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
1106H00000XMarriage & Family Therapist117702CA

General Provider Information

NPI Number : 1366156085
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA ALI AMFT
Provider Business Mailing Address
First Line : 4500 WOODMAN AVE APT A315
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91423-5566
Country : US
Telephone Number : 818-322-5782
Fax Number :
Provider Business Practice Location Address
First Line : 4010 SAWTELLE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-5408
Country : US
Telephone Number : 213-394-2665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2023
Last Update Date : 01/20/2023

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