Individual
GINA ROSE GASTELUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.C.
Contact information
Practice address
3307 RENNER DR, FORTUNA, CA 95540-3119
(707) 725-9832
(707) 725-7247
Mailing address
200 W CENTER STREET PROMENADE STE 300, ANAHEIM, CA 92805-3960
(714) 449-4841
(714) 937-6233
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15240
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA15240
—
CA
Enumeration date
06/06/2006
Last updated
11/02/2021
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