| Doctor Name: | GINA MARIE BACCARI |
| NPI Number: | 1124166467 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | C.C.P.,S.A.-C.,LSA |
| License Number: | PFO207 |
| Business Practice Address: | 3463 Magic Dr Suite T21 San Antonio, TX - 782292973 |
| Business Phone Number: | 2106148101 |
| Business Fax Number: | 2106148102 |
| Mailing Address: | 6742 Manor Hl, SAN ANTONIO |
| State: | TX |
| Postal Code: | 782571107 |
| Phone Number: | 2106989573 |
| Fax Number: | |
| NPI Enumeration Date: | 02/01/2007 |
| NPI Last Update Date: | 04/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | PFO207 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |