Provider Demographics
NPI:1992756977
Name:GIAQUINTO, EDWARD JOHN JR (PHD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:GIAQUINTO
Suffix:JR
Gender:M
Credentials:PHD
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Mailing Address - Street 1:9909 TOPANGA CANYON BLVD # 176
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3602
Mailing Address - Country:US
Mailing Address - Phone:818-618-8830
Mailing Address - Fax:818-626-9022
Practice Address - Street 1:22900 VENTURA BLVD STE 125
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1283
Practice Address - Country:US
Practice Address - Phone:818-618-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY16707103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP16707Medicare UPIN