Healthcare Provider Details

I. General information

NPI: 1326727835
Provider Name (Legal Business Name): MONICA CIASULLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1569 SOLANO AVENUE
RICHMOND CALIFORNIA
94530
UM

IV. Provider business mailing address

310 W M ST
BENICIA CA
94510-2708
US

V. Phone/Fax

Practice location:
  • Phone: 510-230-4973
  • Fax:
Mailing address:
  • Phone: 484-635-6358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number000000000
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: