Active NPI
Kelly Cicotte, PA-C
- Physician Assistant
- El Segundo, CA
National Provider Identifier
1891382719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1194751
- Practice address
- 483 N Aviation Blvd
El Segundo, CA 90245-2808 - Phone
- (310) 653-2873
- NPI assigned
- Dec 26, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1194751 | Primary |
Addresses
Primary practice location
483 N Aviation Blvd
El Segundo, CA 90245-2808
Mailing address
483 N Aviation Blvd
El Segundo, CA 90245-2808
Phone (310) 653-2873
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649721600000",
"number": "1891382719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "483 N AVIATION BLVD",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902452808",
"telephone_number": "310-653-2873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "483 N AVIATION BLVD",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902452808",
"telephone_number": "310-653-2873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CICOTTE",
"first_name": "KELLY",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-26",
"last_updated": "2022-04-12",
"certification_date": "2022-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": "1194751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Segundo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.