Individual
DR. EDUARDO P SICCION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4523 FRUIT ST, LA VERNE, CA 91750-2724
(860) 999-9999
Mailing address
4523 FRUIT ST, LA VERNE, CA 91750-2724
(860) 794-9348
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
041916
CT
207RX0202X
Medical Oncology Physician
Primary
C54593
CA
208M00000X
Hospitalist Physician
C54593
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001419168
—
CT
Enumeration date
10/10/2006
Last updated
03/04/2020
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