Healthcare Provider Details

I. General information

NPI: 1184828659
Provider Name (Legal Business Name): KIRSTEN HOPE FICK P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12556 VALLEY VIEW ST
GARDEN GROVE CA
92845-2006
US

IV. Provider business mailing address

6 MOJO CT
NEWPORT BEACH CA
92663-2334
US

V. Phone/Fax

Practice location:
  • Phone: 714-897-9355
  • Fax: 714-897-5117
Mailing address:
  • Phone: 949-631-1867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: