Individual
MISS GINA M SICLARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1820 41ST AVE STE C, CAPITOLA, CA 95010-2516
(831) 684-7611
(831) 477-2009
Mailing address
3400 DATA DR, ATTN: CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
54957
CA
Other
Enumeration date
09/09/2014
Last updated
03/26/2018
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