MEDICARE: ERICA ANN GIOVINAZZO MS, RD, CSSD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1041392

General Provider Information

NPI Number	:	1679177836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA ANN GIOVINAZZO MS, RD, CSSD

Provider Business Mailing Address
First Line	:	625 N SYCAMORE AVE APT 102
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2036
Country	:	US
Telephone Number	:	917-656-0778
Fax Number	:

Provider Business Practice Location Address
First Line	:	7811 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5302
Country	:	US
Telephone Number	:	917-656-0778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2020
Last Update Date	:	11/27/2020

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