Healthcare Provider Details

I. General information

NPI: 1104548650
Provider Name (Legal Business Name): GIOVANNI CACCIAMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 EASTLAKE AVE STE 7416
LOS ANGELES CA
90089-1020
US

IV. Provider business mailing address

688 S BERENDO ST APT 722
LOS ANGELES CA
90005-1783
US

V. Phone/Fax

Practice location:
  • Phone: 626-491-1531
  • Fax:
Mailing address:
  • Phone: 626-491-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: