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NPI Code Detail

MEDICARE: GINA RENEE LONDON

MEDICARE: GINA RENEE LONDON
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
1101YP2500XProfessional CounselorAPCC16786CA
2101YM0800XMental Health CounselorAPCC16786CA

General Provider Information

NPI Number : 1861341562
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA RENEE LONDON
Provider Business Mailing Address
First Line : PO BOX 1351
Second Line :
City : LODI
State : CA
Zip : 95241-1351
Country : US
Telephone Number : 209-570-6247
Fax Number :
Provider Business Practice Location Address
First Line : 1141 LEVER BLVD
Second Line :
City : STOCKTON
State : CA
Zip : 95206-2855
Country : US
Telephone Number : 209-687-3858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2026
Last Update Date : 01/26/2026

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