Provider Demographics
NPI:1528251550
Name:BANDONI, GINA (LMT #2511, CKT)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:BANDONI
Suffix:
Gender:F
Credentials:LMT #2511, CKT
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:BANDONI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT #2511, CKT
Mailing Address - Street 1:6337 AVENIDA LA COSTA NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4103
Mailing Address - Country:US
Mailing Address - Phone:505-440-7424
Mailing Address - Fax:
Practice Address - Street 1:2509 VERMONT ST NE STE C-3102
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4688
Practice Address - Country:US
Practice Address - Phone:505-440-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2511OtherLMT