Healthcare Provider Details

I. General information

NPI: 1912488933
Provider Name (Legal Business Name): LICE PATROL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 N 13TH ST
GROVER BEACH CA
93433-2231
US

IV. Provider business mailing address

171 N 13TH ST
GROVER BEACH CA
93433-2231
US

V. Phone/Fax

Practice location:
  • Phone: 805-668-2414
  • Fax:
Mailing address:
  • Phone: 805-668-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberLCA761
License Number StateUT

VIII. Authorized Official

Name: MR. ROSE M MOORE
Title or Position: CFO
Credential:
Phone: 805-668-2414