Basic Information
| Provider Information | |||||||||
| NPI: | 1699757211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIANGRECO | ||||||||
| FirstName: | ATILIO | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 669 | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853662329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282476516 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11611 S FOOTHILLS BLVD STE G | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853675845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282479616 | ||||||||
| FaxNumber: | 9282764593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 26569 | AZ | N | Other Service Providers | Specialist | 207RX0202X | 26569 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 432112 | 05 | AZ | MEDICAID |