Individual
GINA IRVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
771 W BLAINE ST # C, RIVERSIDE, CA 92507-3940
(951) 358-4588
Mailing address
771 W BLAINE ST # C, RIVERSIDE, CA 92507-3940
(951) 358-4588
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/27/2015
Last updated
04/06/2016
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