Healthcare Provider Details

I. General information

NPI: 1841048287
Provider Name (Legal Business Name): LOVELY STICKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 JOELLIS WAY
SACRAMENTO CA
95815-3913
US

IV. Provider business mailing address

4500 NATOMAS CENTRAL DR APT 1034
SACRAMENTO CA
95834-7565
US

V. Phone/Fax

Practice location:
  • Phone: 800-536-6331
  • Fax:
Mailing address:
  • Phone: 800-536-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MAKEAL DAVIS
Title or Position: CEO
Credential:
Phone: 800-536-6331