Provider Demographics
NPI:1639182223
Name:GIACONI, JO ANN ANDREA (MD)
Entity Type:Individual
Prefix:
First Name:JO ANN
Middle Name:ANDREA
Last Name:GIACONI
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 1:100 STEIN PLZ
Mailing Address - Street 2:RM-1-340
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7065
Mailing Address - Country:US
Mailing Address - Phone:310-825-5000
Mailing Address - Fax:
Practice Address - Street 1:100 STEIN PLAZA
Practice Address - Street 2:RM-1-340
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-825-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69916207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A699160Medicaid
CAM050376OtherCOUNTY OF LOS ANGELES-UCLA MEDICAL CENTER
CA00A699160Medicaid
CAWA69916AMedicare PIN
CAAR836ZMedicare PIN
CAM050376OtherCOUNTY OF LOS ANGELES-UCLA MEDICAL CENTER