Provider Demographics
NPI:1871689596
Name:SMITH, GIOVANNI MAURO (MD)
Entity Type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:MAURO
Last Name:SMITH
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 1:1030 AVONOAK TER
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1557
Mailing Address - Country:US
Mailing Address - Phone:818-242-7107
Mailing Address - Fax:818-242-7107
Practice Address - Street 1:450 E HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3748
Practice Address - Country:US
Practice Address - Phone:626-462-1884
Practice Address - Fax:626-445-1542
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG73356207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG05786Medicare UPIN