Provider Demographics
NPI:1841986122
Name:ANICO, ALAIN TIONGCO
Entity type:Individual
Prefix:MR
First Name:ALAIN
Middle Name:TIONGCO
Last Name:ANICO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 GELLERT BLVD
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2702
Mailing Address - Country:US
Mailing Address - Phone:415-529-8761
Mailing Address - Fax:
Practice Address - Street 1:10 MORTON DR
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4414
Practice Address - Country:US
Practice Address - Phone:415-529-8761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7264463172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver