Provider Demographics
NPI:1306266101
Name:GIAQUINTO, JAMES RICHARD
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:GIAQUINTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 34TH ST APT H
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2167
Mailing Address - Country:US
Mailing Address - Phone:310-709-9571
Mailing Address - Fax:
Practice Address - Street 1:2440 34TH ST APT H
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2167
Practice Address - Country:US
Practice Address - Phone:310-709-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker