Provider Demographics
NPI:1679856827
Name:ROSSETTI, GINA (MD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:ROSSETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 E WARNER AVE UNIT 1434
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-9031
Mailing Address - Country:US
Mailing Address - Phone:804-332-4303
Mailing Address - Fax:
Practice Address - Street 1:13222 CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4414
Practice Address - Country:US
Practice Address - Phone:855-588-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118518208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902846306OtherGROUP NPI
CAGR0100430OtherGROUP MEDI-CAL
CAW18762OtherGROUP MEDICARE