Provider Demographics
NPI:1699597757
Name:GIOVANINI, JENINE (NP)
Entity type:Individual
Prefix:
First Name:JENINE
Middle Name:
Last Name:GIOVANINI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENINE
Other - Middle Name:
Other - Last Name:RAFFANIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28935 MIRADA CIRCULO
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1589
Mailing Address - Country:US
Mailing Address - Phone:805-328-7100
Mailing Address - Fax:
Practice Address - Street 1:4650 SUNSET BLVD.
Practice Address - Street 2:MAILSTOP #81
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-361-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily