Provider Demographics
NPI:1720180094
Name:NACIANCENO, SALLY ESCARDA (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:ESCARDA
Last Name:NACIANCENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SALOME
Other - Middle Name:ESCARDA
Other - Last Name:NACIANCENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:175 N JACKSON AVE
Mailing Address - Street 2:SUITE #110
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1909
Mailing Address - Country:US
Mailing Address - Phone:408-251-3364
Mailing Address - Fax:408-251-8260
Practice Address - Street 1:175 N JACKSON AVE
Practice Address - Street 2:#110
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1909
Practice Address - Country:US
Practice Address - Phone:408-251-3364
Practice Address - Fax:408-251-8260
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA029762207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology