Individual
DR. NANETTE M MICKIEWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1555 SOQUEL DR, SANTA CRUZ, CA 95065-1705
(831) 462-7512
(415) 591-2446
Mailing address
700 FREDERICK ST, STE 203, SANTA CRUZ, CA 95062-2239
(831) 462-7512
(415) 591-2446
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
G646700
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G646700
—
CA
Enumeration date
05/05/2006
Last updated
02/09/2012
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