Healthcare Provider Details

I. General information

NPI: 1285241778
Provider Name (Legal Business Name): LICE CLINICS OF AMERICA- PLEASANTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 MAIN ST STE H
PLEASANTON CA
94566-6648
US

IV. Provider business mailing address

818 MAIN ST STE H
PLEASANTON CA
94566-6648
US

V. Phone/Fax

Practice location:
  • Phone: 925-400-9696
  • Fax:
Mailing address:
  • Phone: 925-400-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: CINDY BARUKZAI
Title or Position: OWNER
Credential:
Phone: 209-262-5474