Provider Demographics
NPI:1093205213
Name:CICORIA, JESSICA (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CICORIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 WESLEY ST STE 230
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1668
Mailing Address - Country:US
Mailing Address - Phone:360-564-1595
Mailing Address - Fax:360-605-1776
Practice Address - Street 1:875 WESLEY ST STE 230
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1668
Practice Address - Country:US
Practice Address - Phone:360-564-1595
Practice Address - Fax:360-605-1776
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61450605207Q00000X
MEDO3364207Q00000X
IDOC-0302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine