Provider Demographics
NPI:1548892763
Name:PALADY, GINA RENEE (LAC)
Entity type:Individual
Prefix:
First Name:GINA RENEE
Middle Name:
Last Name:PALADY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N MOUNT SHASTA BLVD # 350
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2232
Mailing Address - Country:US
Mailing Address - Phone:530-206-3424
Mailing Address - Fax:
Practice Address - Street 1:407 S MOUNT SHASTA BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2559
Practice Address - Country:US
Practice Address - Phone:530-206-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7394171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist