Provider Demographics
NPI:1629952106
Name:INGOLIA, GIOVANNI (CHW)
Entity type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:
Last Name:INGOLIA
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70232
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92167-1232
Mailing Address - Country:US
Mailing Address - Phone:619-994-8539
Mailing Address - Fax:
Practice Address - Street 1:17130 SEQUOIA ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1403
Practice Address - Country:US
Practice Address - Phone:866-658-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty