Provider Demographics
NPI:1669131371
Name:HARFOUCHE, GIOVANNI JAX (LE)
Entity type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:JAX
Last Name:HARFOUCHE
Suffix:
Gender:M
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 EASTGATE LN
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6530
Mailing Address - Country:US
Mailing Address - Phone:925-594-3039
Mailing Address - Fax:
Practice Address - Street 1:1620 PACHECO BLVD STE C
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-1977
Practice Address - Country:US
Practice Address - Phone:925-594-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist