Healthcare Provider Details

I. General information

NPI: 1053878942
Provider Name (Legal Business Name): DANIELLE GIANQUINTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 10/23/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 HOTEL CIR N
SAN DIEGO CA
92108-2807
US

IV. Provider business mailing address

12975 BROOKPRINTER PL STE 250
POWAY CA
92064-8894
US

V. Phone/Fax

Practice location:
  • Phone: 619-961-2120
  • Fax:
Mailing address:
  • Phone: 858-842-3930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: