Provider Demographics
NPI:1992929392
Name:GIOVANNOLI, MAIA CLARISE (BS)
Entity type:Individual
Prefix:MS
First Name:MAIA
Middle Name:CLARISE
Last Name:GIOVANNOLI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-2512
Mailing Address - Country:US
Mailing Address - Phone:707-696-0038
Mailing Address - Fax:
Practice Address - Street 1:668 QUINAN ST
Practice Address - Street 2:SUITE #100
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1621
Practice Address - Country:US
Practice Address - Phone:510-741-7286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171M00000XOther Service ProvidersCase Manager/Care Coordinator