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NPI Code Detail

MEDICARE: JACKIE NABIL GIRGIS LCSW

MEDICARE: JACKIE NABIL GIRGIS LCSW
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
11041C0700XClinical Social Worker24895CA

General Provider Information

NPI Number : 1699831255
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKIE NABIL GIRGIS LCSW
Provider Business Mailing Address
First Line : 23461 S POINTE DR STE 220
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-1523
Country : US
Telephone Number :
Fax Number : 949-951-2871
Provider Business Practice Location Address
First Line : 23461 S POINTE DR STE 220
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-1523
Country : US
Telephone Number : 949-900-5380
Fax Number : 949-595-0296
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2006
Last Update Date : 07/21/2022

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