Healthcare Provider Details

I. General information

NPI: 1750128880
Provider Name (Legal Business Name): MARIE ANTONETTE SICAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 SILVER CREEK VALLEY RD
SAN JOSE CA
95138-1059
US

IV. Provider business mailing address

3412 STING WAY
STOCKTON CA
95212-2166
US

V. Phone/Fax

Practice location:
  • Phone: 408-574-9252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95323845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: