Provider Demographics
NPI:1316333792
Name:TOMICICH, STEPHANIE SILVIA (NP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:SILVIA
Last Name:TOMICICH
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:PO BOX 33865
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3865
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:858-221-5036
Practice Address - Street 1:9850 GENESEE AVE STE 440
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1212
Practice Address - Country:US
Practice Address - Phone:858-453-5944
Practice Address - Fax:858-429-7925
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2020-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA95002402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95002402OtherNP MEDICAL LICENSE