MEDICARE: MICO HAWKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	347E00000X	Transportation Broker
2	374U00000X	Home Health Aide
3	253Z00000X	In Home Supportive Care Agency
4	251X00000X	Supports Brokerage Agency
5	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1700590569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICO HAWKINS

Provider Business Mailing Address
First Line	:	44616 FIG AVE
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-3415
Country	:	US
Telephone Number	:	661-373-8792
Fax Number	:

Provider Business Practice Location Address
First Line	:	44616 FIG AVE
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-3415
Country	:	US
Telephone Number	:	661-373-8792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	01/06/2023

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Directions to “ MICO HAWKINS ” Practice Location

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