Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC26556 | CA |
N | 111NN1001X | Nutrition | DC26556 | CA |
N | 111NS0005X | Chiropractic Sports Physician | DC26556 | CA |
NPI | 1275635575 |
---|---|
Provider Name | Dr. Angela Cerice Iacovino |
First Address | Newport Beach, CA 92660-5515 |
Second Address | Newport Beach, CA 92660-5538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 17/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0265560 | BLUE CROSS/SHIELD (01) | CA |
DC26556 | (05) | CA |
DC26556 | COMMERCIAL (01) | CA |
DC26556 | HMO (01) | CA |
DC26556 | PPO (01) | CA |
DC26556 | TRICARE (01) | CA |
U78867 | (02) | CA |