Healthcare Provider Details

I. General information

NPI: 1861125163
Provider Name (Legal Business Name): DANIELLE GIACONA DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 W TEFFT ST STE A
NIPOMO CA
93444-9288
US

IV. Provider business mailing address

699 W TEFFT ST STE A
NIPOMO CA
93444-9288
US

V. Phone/Fax

Practice location:
  • Phone: 805-619-5610
  • Fax: 805-619-5179
Mailing address:
  • Phone: 805-619-5610
  • Fax: 805-619-5179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. ALISON CYRILL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 805-481-0938