Provider Demographics
NPI:1053899872
Name:OTFINOWSKI, GIOVANNA A
Entity type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:A
Last Name:OTFINOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-2107
Mailing Address - Country:US
Mailing Address - Phone:510-336-7077
Mailing Address - Fax:
Practice Address - Street 1:342 CASCADE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-2107
Practice Address - Country:US
Practice Address - Phone:510-336-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist