MEDICARE: DANA GIONTA LLC

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	103TH0100X	Health Service Psychologist

General Provider Information

NPI Number	:	1417714619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANA GIONTA LLC

Provider Business Mailing Address
First Line	:	9353 W TWAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6861
Country	:	US
Telephone Number	:	401-524-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	9353 W TWAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6861
Country	:	US
Telephone Number	:	401-524-0090
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	DANA GIONTA
Credential	:	PH.D
Telephone Number	:	401-524-0090

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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Directions to “DANA GIONTA LLC ” Practice Location

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