Healthcare Provider Details

I. General information

NPI: 1699009183
Provider Name (Legal Business Name): JENNIFER GIANNINI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PLZ SUITE 100
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

100 MEDICAL PLZ SUITE 100
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-481-7546
  • Fax: 310-794-9070
Mailing address:
  • Phone: 310-481-7546
  • Fax: 310-794-9070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number19297
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number3252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: