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NPI Code Detail

MEDICARE: DR. NANETTE M MICKIEWICZ MD

MEDICARE: DR. NANETTE M MICKIEWICZ MD
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
1207RI0200XInfectious Disease PhysicianG646700CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558319079
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NANETTE M MICKIEWICZ MD
Provider Business Mailing Address
First Line : 700 FREDERICK ST
Second Line : STE 203
City : SANTA CRUZ
State : CA
Zip : 95062-2239
Country : US
Telephone Number : 831-462-7512
Fax Number : 415-591-2446
Provider Business Practice Location Address
First Line : 1555 SOQUEL DR
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95065-1705
Country : US
Telephone Number : 831-462-7512
Fax Number : 415-591-2446
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 02/09/2012

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