Healthcare Provider Details

I. General information

NPI: 1053185231
Provider Name (Legal Business Name): GINA L CUCCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 SCRIPPS DR STE 203
SACRAMENTO CA
95825-6208
US

IV. Provider business mailing address

4330 GARDEN BAR RD
LINCOLN CA
95648-9719
US

V. Phone/Fax

Practice location:
  • Phone: 916-923-3931
  • Fax:
Mailing address:
  • Phone: 916-599-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number21930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: