Provider Demographics
NPI:1053185231
Name:CUCCIA, GINA L
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:L
Last Name:CUCCIA
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 1:4330 GARDEN BAR RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-9719
Mailing Address - Country:US
Mailing Address - Phone:916-599-6955
Mailing Address - Fax:
Practice Address - Street 1:79 SCRIPPS DR STE 203
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6208
Practice Address - Country:US
Practice Address - Phone:916-923-3931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21930124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist