Provider Demographics
NPI:1912795527
Name:GIACOMINO, GINA LEE
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LEE
Last Name:GIACOMINO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7662 S ABBEY LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0056
Mailing Address - Country:US
Mailing Address - Phone:480-302-1823
Mailing Address - Fax:
Practice Address - Street 1:7662 S ABBEY LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-0056
Practice Address - Country:US
Practice Address - Phone:480-302-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities