Provider Demographics
NPI:1386638971
Name:GIANOS, MARY ELISE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELISE
Last Name:GIANOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 LAS POSAS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1501
Mailing Address - Country:US
Mailing Address - Phone:805-482-5518
Mailing Address - Fax:805-445-9543
Practice Address - Street 1:3901 LAS POSAS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1501
Practice Address - Country:US
Practice Address - Phone:805-482-5518
Practice Address - Fax:805-445-9543
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57446207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E02812Medicare UPIN
CAG057446Medicare ID - Type Unspecified