Healthcare Provider Details

I. General information

NPI: 1902220882
Provider Name (Legal Business Name): DANIEL GIOVINAZZO MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 82163
KENMORE WA
98028-0163
US

IV. Provider business mailing address

PO BOX 82163
KENMORE WA
98028-0163
US

V. Phone/Fax

Practice location:
  • Phone: 360-859-9775
  • Fax: 360-783-7362
Mailing address:
  • Phone: 360-859-9775
  • Fax: 360-783-7362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.MD.61584690
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: