Basic Information
| Provider Information | |||||||||
| NPI: | 1194912162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FALCOCCHIA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 W HERNDON AVE | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936120204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593246200 | ||||||||
| FaxNumber: | 5593246280 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 W HERNDON AVE | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936120204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593246200 | ||||||||
| FaxNumber: | 5593246280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2007 | ||||||||
| LastUpdateDate: | 03/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A98252 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | A98252 | 01 | CA | LICENSE | OTHER | 00A982520 | 05 | CA | MEDICAID | FF0130839 | 01 | CA | DEA | OTHER |