Provider Demographics
NPI:1902102619
Name:SICILIANO, FRED (LAC(LICENSED ACUPU)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:SICILIANO
Suffix:
Gender:M
Credentials:LAC(LICENSED ACUPU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4482 MARKET STREET
Mailing Address - Street 2:SUITE 403
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7780
Mailing Address - Country:US
Mailing Address - Phone:805-654-8776
Mailing Address - Fax:
Practice Address - Street 1:4482 MARKET STREET
Practice Address - Street 2:SUITE 403
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-654-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1315171100000X
AZ0495171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist