Provider Demographics
NPI:1689756256
Name:SCIAMMARELLA, MARIA G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:G
Last Name:SCIAMMARELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4154
Mailing Address - Country:US
Mailing Address - Phone:805-782-8844
Mailing Address - Fax:805-782-8859
Practice Address - Street 1:1941 JOHNSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4154
Practice Address - Country:US
Practice Address - Phone:805-782-8844
Practice Address - Fax:805-782-8859
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72324174400000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0068680Medicaid
CAZZZ28458ZOtherBLUE SHIELD
CAWA72324DMedicare PIN
CAWA72324GMedicare PIN
CAWA72324EMedicare PIN
CAWA72324HMedicare PIN
CAWA72324CMedicare PIN
CAZZZ28458ZOtherBLUE SHIELD
CAWA72324BMedicare PIN