Provider Demographics
NPI:1730936402
Name:GINA HABEEB PHYSICIAN ASSISTANT INC
Entity type:Organization
Organization Name:GINA HABEEB PHYSICIAN ASSISTANT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HABEEB
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:310-619-7370
Mailing Address - Street 1:3400 BAHIA PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-4023
Mailing Address - Country:US
Mailing Address - Phone:310-619-7370
Mailing Address - Fax:888-451-3500
Practice Address - Street 1:2790 SKYPARK DR STE 210
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5388
Practice Address - Country:US
Practice Address - Phone:310-619-7370
Practice Address - Fax:888-451-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty