Individual
CAROL L CANCILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13585 SAN PABLO AVE, SAN PABLO, CA 94806
(510) 942-4712
Mailing address
1340 ARNOLD DR, MARTINEZ, CA 94553-4189
(925) 957-5102
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95203844
CA
Other
Enumeration date
03/04/2022
Last updated
03/04/2022
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