Provider Demographics
NPI:1366624082
Name:ANCIRA, RICHARD (CM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ANCIRA
Suffix:
Gender:M
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 DOWNEY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1208
Mailing Address - Country:US
Mailing Address - Phone:209-558-8159
Mailing Address - Fax:209-558-8648
Practice Address - Street 1:121 DOWNEY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1208
Practice Address - Country:US
Practice Address - Phone:209-558-8159
Practice Address - Fax:209-558-8648
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator