Healthcare Provider Details

I. General information

NPI: 1265291926
Provider Name (Legal Business Name): CHRISTINA FICOVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 PINE LN
LOS ALTOS CA
94022-1694
US

IV. Provider business mailing address

20342 ZORKA AVE
SARATOGA CA
95070-3134
US

V. Phone/Fax

Practice location:
  • Phone: 650-209-3530
  • Fax:
Mailing address:
  • Phone: 408-497-2307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: