Provider Demographics
NPI:1356511513
Name:AVOLICINO, STEVEN JOHN (HT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JOHN
Last Name:AVOLICINO
Suffix:
Gender:M
Credentials:HT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 DEPOT RD
Mailing Address - Street 2:4
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2359
Mailing Address - Country:US
Mailing Address - Phone:510-285-6324
Mailing Address - Fax:510-785-0643
Practice Address - Street 1:2829 DEPOT RD
Practice Address - Street 2:4
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2359
Practice Address - Country:US
Practice Address - Phone:510-285-6324
Practice Address - Fax:510-785-0643
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ43620ZMedicare PIN