1558624148 NPI number — ROGER GIANI MD PROFESSIONAL CORP

Table of content: DR. RICHARD HOUSTON BLAIR AU.D. (NPI 1801087721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558624148 NPI number — ROGER GIANI MD PROFESSIONAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROGER GIANI MD PROFESSIONAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558624148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3444 WHITTIER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90023-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-264-2670
Provider Business Mailing Address Fax Number:
323-264-5754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3444 WHITTIER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90023-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-264-2670
Provider Business Practice Location Address Fax Number:
323-264-5754
Provider Enumeration Date:
06/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GIANI
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
323-264-2670

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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