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NPI Code Detail

MEDICARE: ALICIA MARIE MUCCIGROSSO PA-C

MEDICARE: ALICIA MARIE MUCCIGROSSO PA-C
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
1363A00000XPhysician Assistant21789CA
2363AM0700XMedical Physician Assistant014104-1NY

General Provider Information

NPI Number : 1538472162
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA MARIE MUCCIGROSSO PA-C
Provider Business Mailing Address
First Line : 6330 SAN VICENTE BLVD
Second Line : SUITE 310
City : LOS ANGELES
State : CA
Zip : 90048-5425
Country : US
Telephone Number : 310-855-0751
Fax Number :
Provider Business Practice Location Address
First Line : 6330 SAN VICENTE BLVD
Second Line : SUITE 310
City : LOS ANGELES
State : CA
Zip : 90048-5425
Country : US
Telephone Number : 310-855-0751
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2010
Last Update Date : 11/20/2013

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Directions to “ ALICIA MARIE MUCCIGROSSO PA-C” Practice Location

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