Provider Demographics
NPI:1518438548
Name:SY, GIGIROSE ACHANZAR (RPSGT, CCSH)
Entity Type:Individual
Prefix:
First Name:GIGIROSE
Middle Name:ACHANZAR
Last Name:SY
Suffix:
Gender:F
Credentials:RPSGT, CCSH
Other - Prefix:
Other - First Name:GIGIROSE
Other - Middle Name:MARQUEZ
Other - Last Name:ACHANZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPSGT, CCSH
Mailing Address - Street 1:3600 BROADWAY STE 36
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5730
Mailing Address - Country:US
Mailing Address - Phone:510-752-5242
Mailing Address - Fax:
Practice Address - Street 1:3600 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5730
Practice Address - Country:US
Practice Address - Phone:510-752-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTGL89246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other