Individual
JENNIFER DELA VEGA ICASIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RVS, BS
Contact information
Practice address
333 SUNSET AVE STE 140, SUISUN CITY, CA 94585-2054
(707) 334-1704
Mailing address
333 SUNSET AVE STE 140, SUISUN CITY, CA 94585-2054
(707) 334-1704
Taxonomy
Speciality
Code
Description
License number
State
2471V0105X
Vascular Sonography Radiologic Technologist
Primary
00092881
CA
Other
Enumeration date
08/28/2015
Last updated
08/28/2015
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