Healthcare Provider Details

I. General information

NPI: 1093175697
Provider Name (Legal Business Name): NIKI LOVICK LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO ST 4TH FLOOR BOX 1774
SAN FRANCISCO CA
94143-3010
US

IV. Provider business mailing address

1600 DIVISADERO ST 4TH FLOOR BOX 1774
SAN FRANCISCO CA
94143-3010
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-8778
  • Fax:
Mailing address:
  • Phone: 415-514-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: