Healthcare Provider Details

I. General information

NPI: 1891900544
Provider Name (Legal Business Name): DANIEL CICCARONE MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DFCM, 500 PARNASSUS AVENUE MU-3E, BOX 0900
SAN FRANCISCO CA
94143-0900
US

IV. Provider business mailing address

DFCM, 500 PARNASSUS AVENUE MU-3E, BOX 0900
SAN FRANCISCO CA
94143-0900
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-0275
  • Fax:
Mailing address:
  • Phone: 415-514-0275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG071090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: