Active NPI
Gina Derham
- Physical Therapy Assistant
- San Diego, CA
National Provider Identifier
1881076719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- AT 3602
- Practice address
- 12433 Floresta CT
San Diego, CA 92128-1310 - Phone
- (858) 485-8117
- NPI assigned
- Jun 27, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | AT 3602 | CA | Primary |
Addresses
Primary practice location
12433 Floresta CT
San Diego, CA 92128-1310
Mailing address
12433 Floresta CT
San Diego, CA 92128-1310
Phone (858) 485-8117
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT 3602 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435363200000",
"number": "1881076719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12433 FLORESTA CT",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921281310",
"telephone_number": "858-485-8117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12433 FLORESTA CT",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921281310",
"telephone_number": "858-485-8117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERHAM",
"first_name": "GINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-27",
"last_updated": "2015-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "AT 3602",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.