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General NPI Number Information
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NPI Number | 1174550412
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Entity Type | Organization
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Legal Business Name | GIANGRECO MEDICAL GROUP
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 1951 W 25TH ST SUITE F
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City | YUMA
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State | AZ
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Zip | 85364-6925
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Country | US
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Telephone | 928-314-1174
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Fax | 928-314-1175
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Provider Business Mailing Address
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Address Line | PO BOX 2332
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City | PALM SPRINGS
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State | CA
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Zip | 92263-2332
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Country | US
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Telephone | 760-322-1205
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Fax | 760-778-5770
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Authorized Official
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Title or Position | BILLING OFFICE MANAGER
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Name | TAMIE BAILEY
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Credential |
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Telephone | 760-322-1205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 27310
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License Number State | AZ
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