Provider Demographics
NPI:1881180115
Name:CIESINSKI, CURTIS PAUL (PA)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:PAUL
Last Name:CIESINSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7531
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91802-7531
Mailing Address - Country:US
Mailing Address - Phone:419-852-0838
Mailing Address - Fax:
Practice Address - Street 1:9301 OAKDALE AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-6538
Practice Address - Country:US
Practice Address - Phone:212-604-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55734363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant