Provider Demographics
NPI:1366442204
Name:GIACOPELLI, JOSEPH J (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:GIACOPELLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18080 BEACH BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1342
Mailing Address - Country:US
Mailing Address - Phone:714-841-5055
Mailing Address - Fax:714-841-9595
Practice Address - Street 1:18080 BEACH BLVD
Practice Address - Street 2:STE 102
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1342
Practice Address - Country:US
Practice Address - Phone:714-841-5055
Practice Address - Fax:714-841-9595
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2231213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E22310Medicaid
CA000E22310Medicaid
CAT-11238Medicare UPIN
CA4025380002Medicare NSC