Healthcare Provider Details

I. General information

NPI: 1013428846
Provider Name (Legal Business Name): ADELAIDE ISABELLA DAMBROSIO-HICKS L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7547 E LELAND CIR
MESA AZ
85207-2034
US

IV. Provider business mailing address

510 N FRANCISCA AVE APT C
REDONDO BEACH CA
90277-7306
US

V. Phone/Fax

Practice location:
  • Phone: 480-742-9115
  • Fax: 480-863-1540
Mailing address:
  • Phone: 310-844-7261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: