Provider Demographics
NPI:1891893962
Name:SANICOLAS, MARIA THERESA PANLILIO (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARIA THERESA
Middle Name:PANLILIO
Last Name:SANICOLAS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:610 EUCLID AVE
Mailing Address - Street 2:STE. 304
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2953
Mailing Address - Country:US
Mailing Address - Phone:619-470-6800
Mailing Address - Fax:866-232-7229
Practice Address - Street 1:610 EUCLID AVE
Practice Address - Street 2:STE. 304
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2953
Practice Address - Country:US
Practice Address - Phone:619-470-6800
Practice Address - Fax:866-232-7229
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4303213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E43030Medicaid
CA4376470001Medicare NSC
CAU74724Medicare UPIN