Individual
COLIN GLYNN CUSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
3901 LONE TREE WAY, ANTIOCH, CA 94509-6200
(925) 779-7200
Mailing address
8238 GOLF LINKS RD, OAKLAND, CA 94605-3537
(313) 268-4906
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
54485
CA
Other
Enumeration date
07/18/2017
Last updated
07/18/2017
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