| Doctor Name: | CHARITY SIASOCO |
| NPI Number: | 1134413768 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RT (R) (M) |
| License Number: | 311095 |
| Business Practice Address: | 438 Orange Ave Coronado, CA - 921181847 |
| Business Phone Number: | 6192523653 |
| Business Fax Number: | |
| Mailing Address: | 438 Orange Ave, CORONADO |
| State: | CA |
| Postal Code: | 921181847 |
| Phone Number: | 6192523653 |
| Fax Number: | |
| NPI Enumeration Date: | 05/31/2011 |
| NPI Last Update Date: | 05/31/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471C3402X |
| License Number: | 311095 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Radiography |
| Taxonomy Definition: | |