Basic Information
Provider Information
NPI: 1003140336
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: IACOVIELLO
FirstName: CECILIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 33205 TEMECULA PARKWAY
Address2:  
City: TEMECULA
State: CA
PostalCode: 92592
CountryCode: US
TelephoneNumber: 9513033164
FaxNumber:  
Practice Location
Address1: 33205 TEMECULA PKWY
Address2:  
City: TEMECULA
State: CA
PostalCode: 925929142
CountryCode: US
TelephoneNumber: 9513033104
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/18/2009
LastUpdateDate: 03/22/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X18942CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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