Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | A122851 | CA |
N | 207VX0201X | Gynecologic Oncologist | A122851 | CA |
NPI | 1154672152 |
---|---|
Provider Name | Dr. Marcia Amelia Ciccone |
First Address | Los Angeles, CA 90033-5313 |
Second Address | Glendale, CA 91208-1468 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2012 |
Last Update Date | 20/08/2020 |