Provider Demographics
NPI:1679177836
Name:GIOVINAZZO, ERICA ANN (MS, RD, CSSD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:GIOVINAZZO
Suffix:
Gender:F
Credentials:MS, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 N SYCAMORE AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2036
Mailing Address - Country:US
Mailing Address - Phone:917-656-0778
Mailing Address - Fax:
Practice Address - Street 1:7811 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5302
Practice Address - Country:US
Practice Address - Phone:917-656-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041392133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered