Healthcare Provider Details

I. General information

NPI: 1073096061
Provider Name (Legal Business Name): REGINA SICILIANO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 D ST STE 105
SAN RAFAEL CA
94901-2839
US

IV. Provider business mailing address

1099 D ST STE 105
SAN RAFAEL CA
94901-2839
US

V. Phone/Fax

Practice location:
  • Phone: 415-532-8335
  • Fax:
Mailing address:
  • Phone: 415-532-8335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: