Provider Demographics
NPI:1245042944
Name:SICKLE CELL DISEASE ENHANCED CARE MANAGEMENT
Entity type:Organization
Organization Name:SICKLE CELL DISEASE ENHANCED CARE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CIANCIULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-375-0503
Mailing Address - Street 1:701 S PARKER ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4727
Mailing Address - Country:US
Mailing Address - Phone:657-375-0503
Mailing Address - Fax:
Practice Address - Street 1:701 S PARKER ST STE 1200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4727
Practice Address - Country:US
Practice Address - Phone:657-375-0503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR COMPREHENSIVE CARE & DIAGNOSIS OF INHERITED BLOOD DISOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty