Healthcare Provider Details

I. General information

NPI: 1972794857
Provider Name (Legal Business Name): JUAN CARLOS GIACHINO MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SE OSCEOLA ST
STUART FL
34994-2505
US

IV. Provider business mailing address

1801 SE HILLMOOR DR STE A-107
PORT SAINT LUCIE FL
34952-7545
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-8160
  • Fax: 772-283-8177
Mailing address:
  • Phone: 772-283-8160
  • Fax: 772-283-8177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME86071
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0032724
License Number StateFL

VIII. Authorized Official

Name: DR. JUAN C GIACHINO SR.
Title or Position: OWNER
Credential: MD
Phone: 772-283-8160