Provider Demographics
NPI:1831275254
Name:GIACOBAZZI, PETER FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:FRANCIS
Last Name:GIACOBAZZI
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 1:18372 CLARK STREET #204
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-342-4541
Mailing Address - Fax:818-342-2403
Practice Address - Street 1:18372 CLARK ST STE 204
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3554
Practice Address - Country:US
Practice Address - Phone:818-342-4541
Practice Address - Fax:818-342-2403
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG181752086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A90530Medicare UPIN
G18175Medicare ID - Type Unspecified