Individual
MIRKO ANDREW GIACONI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 S GAFFEY ST, SAN PEDRO, CA 90731-4628
(310) 548-0201
(310) 548-4492
Mailing address
1600 S GAFFEY ST, SAN PEDRO, CA 90731-4628
(310) 548-0201
(310) 548-4492
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A25678
CA
207RC0000X
Cardiovascular Disease Physician
Primary
A25678
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A256780
—
CA
Enumeration date
12/01/2005
Last updated
09/25/2020
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