MEDICARE: JOHN RUSSELL GIANNINI PA

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	363A00000X	Physician Assistant	PA 20771	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1740339274	OTHER	CA	GROUP NPI

General Provider Information

NPI Number	:	1336262070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN RUSSELL GIANNINI PA

Provider Business Mailing Address
First Line	:	PO BOX 151
Second Line	:
City	:	NORCO
State	:	CA
Zip	:	92860-0151
Country	:	US
Telephone Number	:	323-271-4173
Fax Number	:	951-215-2620

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD STE 408
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3905
Country	:	US
Telephone Number	:	323-271-4173
Fax Number	:	213-621-9584

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	02/08/2022

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