MEDICARE: RENEE CINCO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 19520	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT19520	OTHER	CA	CA PT LICENSE

General Provider Information

NPI Number	:	1225052806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE CINCO PT

Provider Business Mailing Address
First Line	:	7333 ADONIS CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1620
Country	:	US
Telephone Number	:	619-813-1417
Fax Number	:

Provider Business Practice Location Address
First Line	:	5190 GOVERNOR DR
Second Line	:	SUITE 107
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2847
Country	:	US
Telephone Number	:	858-452-0282
Fax Number	:	858-452-6837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/29/2022

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Directions to “ RENEE CINCO PT” Practice Location

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