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Individual

CHARITY SIASOCO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RT (R) (M)

Contact information

Practice address
438 ORANGE AVE, CORONADO, CA 92118-1847
(619) 252-3653
Mailing address
438 ORANGE AVE, CORONADO, CA 92118-1847
(619) 252-3653

Taxonomy

Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
311095
MI
2471M2300X
Mammography Radiologic Technologist
Primary
311095
MI

Other

Enumeration date
05/31/2011
Last updated
05/31/2011
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