Provider Demographics
NPI:1871994939
Name:SICLARI, GINA M (PA-C)
Entity type:Individual
Prefix:MISS
First Name:GINA
Middle Name:M
Last Name:SICLARI
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN: CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1820 41ST AVE STE C
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2516
Practice Address - Country:US
Practice Address - Phone:831-684-7611
Practice Address - Fax:831-477-2009
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2018-03-26
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Provider Licenses
StateLicense IDTaxonomies
CA54957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant