Healthcare Provider Details

I. General information

NPI: 1699597757
Provider Name (Legal Business Name): JENINE GIOVANINI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENINE RAFFANIELLO

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SUNSET BLVD. MAILSTOP #81
LOS ANGELES CA
90027
US

IV. Provider business mailing address

28935 MIRADA CIRCULO
VALENCIA CA
91354-1589
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-3033
  • Fax:
Mailing address:
  • Phone: 805-328-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: