Provider Demographics
NPI:1295175628
Name:GIACONA, DANIELLE ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:ELIZABETH
Last Name:GIACONA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 W TEFFT ST STE A
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9288
Mailing Address - Country:US
Mailing Address - Phone:805-619-5610
Mailing Address - Fax:805-619-5179
Practice Address - Street 1:699 W TEFFT ST STE A
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-9288
Practice Address - Country:US
Practice Address - Phone:805-619-5610
Practice Address - Fax:805-619-5179
Is Sole Proprietor?:No
Enumeration Date:2013-06-29
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18168208200000X
IAR-11063208600000X
CA20A181682086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery