Organization
SALLY E NACIANCENO MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SALLY E NACIANCENO MD (PRESIDENT)
(408) 251-3364
Entity
Organization
Contact information
Practice address
175 N JACKSON AVE STE 110, SAN JOSE, CA 95116-1909
(408) 251-3364
Mailing address
175 N JACKSON AVE STE 110, SAN JOSE, CA 95116-1909
(408) 251-3364
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
A29762
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A29762
MEDICAL LICENSE NO.
CA
Enumeration date
04/13/2007
Last updated
06/23/2008
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