Individual
JOSEPH ISAAC LICATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2301 ERWIN RD, DURHAM, NC 27705-4699
(919) 684-8111
Mailing address
2301 ERWIN RD, DURHAM, NC 27701-9890
(919) 684-8111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-06709
NC
390200000X
Student in an Organized Health Care Education/Training Program
001006709
NC
Other
Enumeration date
09/27/2016
Last updated
07/10/2023
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