Provider Demographics
NPI:1942411178
Name:VESCOVO, GINA EVELYN (MD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:EVELYN
Last Name:VESCOVO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:17035 FAYSMITH AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-2411
Mailing Address - Country:US
Mailing Address - Phone:310-721-8435
Mailing Address - Fax:
Practice Address - Street 1:1057 PINE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3118
Practice Address - Country:US
Practice Address - Phone:562-264-3558
Practice Address - Fax:562-366-5903
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA055462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA055462OtherSTATE LISCENSURE