Organization
MIRKO A GIACONI MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRKO ANDREW GIACONI MD (PRESIDENT)
(310) 832-7541
Entity
Organization
Contact information
Practice address
1360 WEST 6TH ST, STE 205, SAN PEDRO, CA 90732
(310) 832-7541
(310) 832-3585
Mailing address
1360 WEST 6TH ST, STE 205, SAN PEDRO, CA 90732
(310) 832-7541
(310) 832-3585
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A25678
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A25678
—
CA
Enumeration date
08/02/2006
Last updated
02/28/2013
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