Healthcare Provider Details

I. General information

NPI: 1366236952
Provider Name (Legal Business Name): CHRISTINE MARIE CICCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525-1521 B STREET
HAYWARD CA
94541
US

IV. Provider business mailing address

6937 VILLAGE PKWY UNIT 2074
DUBLIN CA
94568-6003
US

V. Phone/Fax

Practice location:
  • Phone: 510-963-9848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: