Individual
AUGUSTO JORGE CIANCIABELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
PA20179
CA
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA20179
CALIFORNIA LICENSE
CA
01
—
PA9105911
LICENSE
FL
01
—
Y06SS
BCBS FL
FL
Enumeration date
02/02/2009
Last updated
08/09/2022
Update your record
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