Provider Demographics
NPI:1245562693
Name:GIOVANNI WIGS OF LUV
Entity Type:Organization
Organization Name:GIOVANNI WIGS OF LUV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-908-2474
Mailing Address - Street 1:14316 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1944
Mailing Address - Country:US
Mailing Address - Phone:818-908-2474
Mailing Address - Fax:818-908-0809
Practice Address - Street 1:14316 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1944
Practice Address - Country:US
Practice Address - Phone:818-908-2474
Practice Address - Fax:818-908-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable