| Doctor Name: | JENNIFER DELA VEGA ICASIANO |
| NPI Number: | 1063889830 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RVS, BS |
| License Number: | 00092881 |
| Business Practice Address: | 333 Sunset Ave Ste 140 Suisun City, CA - 945852054 |
| Business Phone Number: | 7073341704 |
| Business Fax Number: | |
| Mailing Address: | 333 Sunset Ave Ste 140, SUISUN CITY |
| State: | CA |
| Postal Code: | 945852054 |
| Phone Number: | 7073341704 |
| Fax Number: | |
| NPI Enumeration Date: | 08/28/2015 |
| NPI Last Update Date: | 08/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471V0105X |
| License Number: | 00092881 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Vascular Sonography |
| Taxonomy Definition: | |