Healthcare Provider Details

I. General information

NPI: 1740107291
Provider Name (Legal Business Name): GIANNA ETOILE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8623 S VERMONT AVE APT 6
LOS ANGELES CA
90044-4855
US

IV. Provider business mailing address

718 S ALVARADO ST APT 310
LOS ANGELES CA
90057-4046
US

V. Phone/Fax

Practice location:
  • Phone: 323-781-5238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-XYCEZF
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: