Healthcare Provider Details

I. General information

NPI: 1295681450
Provider Name (Legal Business Name): GIANA WALLER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 MISSION GORGE RD STE 108
SAN DIEGO CA
92120-3425
US

IV. Provider business mailing address

6160 MISSION GORGE RD STE 108
SAN DIEGO CA
92120-3425
US

V. Phone/Fax

Practice location:
  • Phone: 619-481-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC21591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: