Provider Demographics
NPI:1538147459
Name:CARAVAGLIA, GINA M (DO)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:CARAVAGLIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 VIA MINORCA
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-1526
Mailing Address - Country:US
Mailing Address - Phone:760-992-3473
Mailing Address - Fax:760-797-7337
Practice Address - Street 1:67580 JONES RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-6401
Practice Address - Country:US
Practice Address - Phone:760-992-3473
Practice Address - Fax:760-797-7337
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2OA-8781207QA0401X
OK4574208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200122600AMedicaid
OK200122600AMedicaid