MEDICARE: GIANA LYNNE WINSTON-RUSSELL

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1891965760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIANA LYNNE WINSTON-RUSSELL

Provider Business Mailing Address
First Line	:	6673 CHARLENE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-1616
Country	:	US
Telephone Number	:	619-750-4040
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 EL CAJON BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4450
Country	:	US
Telephone Number	:	619-597-7335
Fax Number	:	619-642-2735

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

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	01/07/2021

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