Healthcare Provider Details

I. General information

NPI: 1568017978
Provider Name (Legal Business Name): JOSE GULICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2019
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MAGNOLIA AVE
LONG BEACH CA
90806-4521
US

IV. Provider business mailing address

1725 N CONCERTO DR
ANAHEIM CA
92807-2009
US

V. Phone/Fax

Practice location:
  • Phone: 562-218-1868
  • Fax: 562-591-0346
Mailing address:
  • Phone: 562-218-1868
  • Fax: 562-591-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number286682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: