Provider Demographics
NPI:1033418108
Name:GIACONA, JUDITH (RN, PHN, MA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:GIACONA
Suffix:
Gender:F
Credentials:RN, PHN, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35080 BUENA MESA DR
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-1904
Mailing Address - Country:US
Mailing Address - Phone:909-389-3272
Mailing Address - Fax:909-389-0772
Practice Address - Street 1:11711 SAND CANYON RD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-1742
Practice Address - Country:US
Practice Address - Phone:909-389-3272
Practice Address - Fax:909-389-0772
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242096163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health