Provider Demographics
NPI:1538794797
Name:SICAT, MARITES M
Entity type:Individual
Prefix:
First Name:MARITES
Middle Name:M
Last Name:SICAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 BURLWAY RD STE 523
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1714
Mailing Address - Country:US
Mailing Address - Phone:650-581-1359
Mailing Address - Fax:
Practice Address - Street 1:1710 S AMPHLETT BLVD STE 112
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2704
Practice Address - Country:US
Practice Address - Phone:650-286-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist