Healthcare Provider Details

I. General information

NPI: 1336158302
Provider Name (Legal Business Name): GARY INCAUDO M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STE 110 145 MISSION RANCH BLVD
CHICO CA
95926-2175
US

IV. Provider business mailing address

STE 110 145 MISSION RANCH BLVD
CHICO CA
95926-2175
US

V. Phone/Fax

Practice location:
  • Phone: 530-896-2200
  • Fax: 530-896-2209
Mailing address:
  • Phone: 530-896-2200
  • Fax: 530-896-2209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY A INCAUDO
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 530-896-2200