=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700398559
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA CUCICEA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2017
-----------------------------------------------------
Last Update Date | 11/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8734 SOTHEBY CT
-----------------------------------------------------
City | FAIR OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95628-5468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-534-7608
-----------------------------------------------------
Fax | 916-534-7609
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8734 SOTHEBY CT
-----------------------------------------------------
City | FAIR OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95628-5468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-534-7608
-----------------------------------------------------
Fax | 916-534-7609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------