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Individual

EILEEN LUHA SICANGCO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
445 W EATON AVE, TRACY, CA 95376-3420
(209) 524-1211
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
C151916
CA
207Q00000X
Family Medicine Physician
0101244121
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1780876193
VA
Enumeration date
08/10/2007
Last updated
03/17/2018
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