Tracy L Wickware in San Diego - Physician Assistant
Tracy L Wickware - NPI 1417025636
Tracy L Wickware is a Physician Assistant in San Diego, California. Tracy L Wickware practices all healthcare services and medical treatments related to Physician Assistant. The NPI Number for Tracy L Wickware is 1417025636. The last update date is 2023-03-07.
Tracy L Wickware's current location address is 3930 4th Ave, San Diego, California. You can contact this provider via phone number 6192979610 and fax number 6192972244. The mailing address for Tracy L Wickware is 3930 4th Ave, San Diego, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Tracy L Wickware |
|---|---|
| Address | 3930 4th Ave, San Diego, California |
| Phone Number | 6192979610 |
| Fax Number | 6192972244 |
| Sole Proprietor | N |
| Credentials | PA |
NPI Number Detail
| NPI Number | 1417025636 |
|---|---|
| Provider Enumeration Date | 2006-12-04 |
| Last Updated Date | 2023-03-07 |
Provider Mailing Address Detail
| Address | 3930 4th Ave |
|---|---|
| City | San Diego |
| State | California (CA) |
| Post Code | 921033119 |
| Phone Number | 6192979610 |
| Fax Number | 6192972244 |
Provider's Primary Taxonomy Detail
| Speciality | Physician Assistant |
|---|---|
| Taxonomy | 363A00000X |
| Licence No | PA17814 |
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Definition: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perfor |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| PA 17814 | CA | CALIFORNIA LICENSE |
Post Comment/ Review Below
What is the Tracy L Wickware's unique identification number?
The Tracy L Wickware has been assigned the NPI (National Provider Identifier) Number 1417025636 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Where is the Tracy L Wickware located?
The Tracy L Wickware is located at 3930 4Th Ave, San Diego, CA 921033119.
What is Tracy L Wickware's area of expertise and its corresponding taxonomy classification?
The Tracy L Wickware's field of specialization is Physician Assistant, and it falls under the taxonomy code 363A00000X, which categorizes healthcare providers based on their areas of practice.
On what date did the Centers for Medicare & Medicaid Services issue the 1417025636 to Tracy L Wickware?
The Tracy L Wickware received its 1417025636 assignment from the Centers for Medicare & Medicaid Services on 2006-12-04.
As of what date was the information pertaining to Tracy L Wickware, such as address, specialty, and other details, last reviewed and confirmed to be accurate?
The information related to Tracy L Wickware, including its address, specialty, and other relevant details, was last reviewed and confirmed to be accurate on 2023-03-07.