Provider Demographics
NPI:1811136658
Name:MODICA, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:MODICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45012 W HONEYCUTT AVE
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239-2842
Mailing Address - Country:US
Mailing Address - Phone:520-568-5100
Mailing Address - Fax:520-568-5151
Practice Address - Street 1:45012 W HONEYCUTT AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239-2842
Practice Address - Country:US
Practice Address - Phone:520-560-5100
Practice Address - Fax:520-568-5151
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14N00000X146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic