Basic Information
Provider Information
NPI: 1073053229
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GIOIENI
FirstName: SHURIEE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1608 E CHERRY AVE
Address2:  
City: LOMPOC
State: CA
PostalCode: 934363705
CountryCode: US
TelephoneNumber: 8057571171
FaxNumber:  
Practice Location
Address1: 401 E CYPRESS AVE
Address2:  
City: LOMPOC
State: CA
PostalCode: 934366806
CountryCode: US
TelephoneNumber: 8058651940
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/06/2017
LastUpdateDate: 03/06/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X  Y Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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