MEDICARE: HYBRID HEALTHCARE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC24610	CA
2	207L00000X	Anesthesiology Physician	A63560	CA

General Provider Information

NPI Number	:	1417350133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYBRID HEALTHCARE CORPORATION

Provider Business Mailing Address
First Line	:	4519 ALAMO ST
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-1734
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4519 ALAMO ST
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-1734
Country	:	US
Telephone Number	:	805-584-1634
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER SILECCHIO
Credential	:
Telephone Number	:	805-584-1634

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	10/15/2014

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