Provider Demographics
NPI:1164866257
Name:SIONGCO, ARTURO LEONARDO IGNACO (SUBIDC)
Entity Type:Individual
Prefix:
First Name:ARTURO LEONARDO
Middle Name:IGNACO
Last Name:SIONGCO
Suffix:
Gender:M
Credentials:SUBIDC
Other - Prefix:
Other - First Name:ARTURO
Other - Middle Name:IGNACO
Other - Last Name:SIONGCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SUB IDC
Mailing Address - Street 1:159 TROUT AVE
Mailing Address - Street 2:
Mailing Address - City:GROTN
Mailing Address - State:CT
Mailing Address - Zip Code:06349
Mailing Address - Country:US
Mailing Address - Phone:860-910-6045
Mailing Address - Fax:
Practice Address - Street 1:159 TROUT AVE
Practice Address - Street 2:
Practice Address - City:GROTN
Practice Address - State:CT
Practice Address - Zip Code:06349
Practice Address - Country:US
Practice Address - Phone:860-910-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8481OtherINDEPENDENT DUTY CORPSMAN