Organization
GINOS WIDE SHOES & SHOE REPAIR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PABLO SERRANO JR. (OWNER)
(619) 433-4466
Entity
Organization
Contact information
Practice address
5500 GROSSMONT CENTER DR STE 141, STE 141, LA MESA, CA 91942-3070
(619) 433-4466
(619) 439-6787
Mailing address
5500 GROSSMONT CENTER DR STE 141, STE 141, LA MESA, CA 91942-3070
(619) 433-4466
(619) 439-6787
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
02/04/2026
Last updated
02/04/2026
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