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General NPI Number Information
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NPI Number | 1336262070
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Entity Type | Individual
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Provider Name | JOHN RUSSELL GIANNINI PA
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Gender | Male
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 1127 WILSHIRE BLVD STE 408
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City | LOS ANGELES
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State | CA
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Zip | 90017-3905
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Country | US
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Telephone | 323-271-4173
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Fax | 213-621-9584
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Provider Business Mailing Address
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Address Line | PO BOX 151
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City | NORCO
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State | CA
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Zip | 92860-0151
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Country | US
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Telephone | 323-271-4173
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Fax | 951-215-2620
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 20771
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License Number State | CA
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