MEDICARE: KHATRINA GANO

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	183700000X	Pharmacy Technician	167334	CA

General Provider Information

NPI Number	:	1376244434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHATRINA GANO

Provider Business Mailing Address
First Line	:	1320 W HILLSDALE BLVD
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-3125
Country	:	US
Telephone Number	:	650-570-6094
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 W HILLSDALE BLVD
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-3125
Country	:	US
Telephone Number	:	650-570-6094
Fax Number	:

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

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	03/15/2023

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