Provider Demographics
NPI:1669752507
Name:GIRONELLA, LOUIE
Entity type:Individual
Prefix:
First Name:LOUIE
Middle Name:
Last Name:GIRONELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W BARNARD ST APT D241
Mailing Address - Street 2:BAYFIELD APARTMENTS
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1586
Mailing Address - Country:US
Mailing Address - Phone:925-699-8813
Mailing Address - Fax:
Practice Address - Street 1:890 E HOBSON WAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1800
Practice Address - Country:US
Practice Address - Phone:760-922-9867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist