Healthcare Provider Details

I. General information

NPI: 1992929392
Provider Name (Legal Business Name): MAIA CLARISE GIOVANNOLI B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 QUINAN ST SUITE #100
PINOLE CA
94564-1621
US

IV. Provider business mailing address

3349 BRENTWOOD AVE
EL SOBRANTE CA
94803-2512
US

V. Phone/Fax

Practice location:
  • Phone: 510-741-7286
  • Fax:
Mailing address:
  • Phone: 707-696-0038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: