Provider Demographics
NPI:1043350085
Name:DIGIOVANNI, GINA JOANNE (NP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:JOANNE
Last Name:DIGIOVANNI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 LINCOLN BLVD # 214
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4619
Mailing Address - Country:US
Mailing Address - Phone:310-456-8796
Mailing Address - Fax:310-456-8794
Practice Address - Street 1:351 S. HUDSON
Practice Address - Street 2:SUITE NUMBER 130
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91109
Practice Address - Country:US
Practice Address - Phone:626-795-6981
Practice Address - Fax:626-578-1204
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347984363LA2200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS1964881Medicaid