Provider Demographics
NPI:1417945684
Name:GIOVANNINI, ANDREW M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:GIOVANNINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3490 20TH ST
Mailing Address - Street 2:2ND FOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2582
Mailing Address - Country:US
Mailing Address - Phone:415-648-8400
Mailing Address - Fax:415-648-4021
Practice Address - Street 1:3490 20TH ST
Practice Address - Street 2:2ND FOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2582
Practice Address - Country:US
Practice Address - Phone:415-648-8400
Practice Address - Fax:415-648-4021
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG10958174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ72518ZMedicare ID - Type UnspecifiedMEDICARE-MEDICAID
CAA38144Medicare UPIN