Healthcare Provider Details

I. General information

NPI: 1346411071
Provider Name (Legal Business Name): LICE CONTROL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3189 CASTRO VALLEY BLVD
CASTRO VALLEY CA
94546-5531
US

IV. Provider business mailing address

3189 CASTRO VALLEY BLVD
CASTRO VALLEY CA
94546-5531
US

V. Phone/Fax

Practice location:
  • Phone: 510-727-1280
  • Fax: 510-727-1874
Mailing address:
  • Phone: 510-727-1280
  • Fax: 510-727-1874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND TELLEZ RUIZ
Title or Position: OWNER
Credential:
Phone: 949-764-1700