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General NPI Number Information
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NPI Number | 1861775835
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Entity Type | Organization
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Legal Business Name | PETER F GIACOBAZZI MD INC A MED CORP
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 18372 CLARK ST STE 204
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City | TARZANA
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State | CA
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Zip | 91356-3554
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Country | US
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Telephone | 818-342-4541
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Fax | 818-342-2403
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Provider Business Mailing Address
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Address Line | 18372 CLARK ST STE 204
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City | TARZANA
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State | CA
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Zip | 91356-3554
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Country | US
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Telephone | 818-342-4541
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Fax | 818-342-2403
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER F. GIACOBAZZI
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Credential | M.D.
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Telephone | 818-342-4541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G18175
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License Number State | CA
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