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General NPI Number Information
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NPI Number | 1134413768
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Entity Type | Individual
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Provider Name | CHARITY SIASOCO RT (R) (M)
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Gender | Female
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 438 ORANGE AVE
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City | CORONADO
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State | CA
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Zip | 92118-1847
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Country | US
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Telephone | 619-252-3653
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Fax |
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Provider Business Mailing Address
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Address Line | 438 ORANGE AVE
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City | CORONADO
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State | CA
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Zip | 92118-1847
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Country | US
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Telephone | 619-252-3653
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number | 311095
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2471M2300X
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Taxonomy Name | Mammography Radiologic Technologist
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License Number | 311095
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License Number State | MI
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