Provider Demographics
NPI:1740390574
Name:GIANGRECO, LOUANNE LANE (MD)
Entity type:Individual
Prefix:
First Name:LOUANNE
Middle Name:LANE
Last Name:GIANGRECO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOUANNE
Other - Middle Name:LANE
Other - Last Name:TEN KATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1260 B ST STE 125
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2934
Mailing Address - Country:US
Mailing Address - Phone:510-471-5880
Mailing Address - Fax:
Practice Address - Street 1:22331 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3911
Practice Address - Country:US
Practice Address - Phone:510-471-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIME164287207P00000X
TN69938207P00000X
FLME164287207P00000X
NY236573207P00000X
ALMD.47637207P00000X
CAC198335207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02683714Medicaid
I38311Medicare UPIN
NYRA7686Medicare ID - Type Unspecified