MEDICARE: DAVID A DICICCO PHD

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	103TC0700X	Clinical Psychologist	PSY5667	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669467015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A DICICCO PHD

Provider Business Mailing Address
First Line	:	5190 GOVERNOR DR
Second Line	:	STE 108
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2847
Country	:	US
Telephone Number	:	858-546-1211
Fax Number	:	858-546-0411

Provider Business Practice Location Address
First Line	:	5190 GOVERNOR DR
Second Line	:	STE 108
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2847
Country	:	US
Telephone Number	:	858-546-1211
Fax Number	:	858-546-0411

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

Similar Medicare Providers

1851392120 — MS. GLORIA THERESA SIGAFOOS PT OCS CHT
Practice Location Address:

5190 GOVERNOR DR , #107
SAN DIEGO, CA
92122-2847

Practice Phone: 858-452-0282
Practice Fax: 858-452-6837

1770584062 — UNIVERSITY CITY PHYSICAL THERAPY
Practice Location Address:

5190 GOVERNOR DR , #107
SAN DIEGO, CA
92122-2847

Practice Phone: 858-452-0282
Practice Fax: 858-452-6837

1003801457 — F VICTORIA DICICCO PHD
Practice Location Address:

5190 GOVERNOR DR , STE 108
SAN DIEGO, CA
92122-2847

Practice Phone: 858-452-5800
Practice Fax: 858-546-0411

1336112721 — DR. LEE JAMES SLATER DDS, MS
Practice Location Address:

5190 GOVERNOR DR , SUITE 106
SAN DIEGO, CA
92122-2847

Practice Phone: 858-784-0600
Practice Fax: 858-784-0604

1225052806 — RENEE CINCO PT
Practice Location Address:

5190 GOVERNOR DR , SUITE 107
SAN DIEGO, CA
92122-2847

Practice Phone: 858-452-0282
Practice Fax: 858-452-6837

1447316419 — MS. PENNY JOAN FOREMAN MSW
Practice Location Address:

5190 GOVERNOR DR , SUITE 104
SAN DIEGO, CA
92122-2847

Practice Phone: 858-657-0007
Practice Fax: 734-448-0423

Directions to “ DAVID A DICICCO PHD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.