Healthcare Provider Details

I. General information

NPI: 1609316538
Provider Name (Legal Business Name): KRISTOF SICIARZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2017
Last Update Date: 02/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 HARBOR BLVD STE 351
OXNARD CA
93035-4136
US

IV. Provider business mailing address

3600 HARBOR BLVD STE 351
OXNARD CA
93035-4136
US

V. Phone/Fax

Practice location:
  • Phone: 305-394-5577
  • Fax:
Mailing address:
  • Phone: 305-394-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA44892
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16317
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: