MEDICARE: DAVID GIELLA PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY22230	CA

General Provider Information

NPI Number	:	1083817951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID GIELLA PSYD

Provider Business Mailing Address
First Line	:	10907 MAGNOLIA BLVD
Second Line	:	SUITE 414
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-3904
Country	:	US
Telephone Number	:	818-439-4715
Fax Number	:

Provider Business Practice Location Address
First Line	:	10907 MAGNOLIA BLVD
Second Line	:	SUITE 414
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-3904
Country	:	US
Telephone Number	:	818-439-4715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	10/08/2008

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