# GINOS WIDE SHOES & SHOE REPAIR

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073464350
- **Authorized official:** PABLO SERRANO JR. (OWNER)
- **Authorized official phone:** (619) 433-4466

## Contact information

- **Practice address:** 5500 GROSSMONT CENTER DR STE 141, STE 141, LA MESA, CA 91942-3070
- **Practice address phone:** (619) 433-4466
- **Practice address fax:** (619) 439-6787
- **Mailing address:** 5500 GROSSMONT CENTER DR STE 141, STE 141, LA MESA, CA 91942-3070
- **Mailing address phone:** (619) 433-4466
- **Mailing address fax:** (619) 439-6787

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | — |

## Other

- **Enumeration date:** 02/04/2026
- **Last updated:** 02/04/2026