Healthcare Provider Details

I. General information

NPI: 1255841045
Provider Name (Legal Business Name): LICE CLINICS OF AMERICA - SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SNEATH LN STE 107
SAN BRUNO CA
94066-2349
US

IV. Provider business mailing address

1121 SAN ANSELMO AVE
MILLBRAE CA
94030-1413
US

V. Phone/Fax

Practice location:
  • Phone: 650-746-8788
  • Fax:
Mailing address:
  • Phone: 408-780-6936
  • 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: JACQUELINE HUYNH
Title or Position: MANAGER/OWNER
Credential:
Phone: 650-746-8788