Healthcare Provider Details

I. General information

NPI: 1497069769
Provider Name (Legal Business Name): JAMES ALLEN STICE R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W. TUNNEL
SANTA MARIA CA
93454
US

IV. Provider business mailing address

2049 BUSH DR
LOS OSOS CA
93402-3220
US

V. Phone/Fax

Practice location:
  • Phone: 805-614-4940
  • Fax:
Mailing address:
  • Phone: 805-903-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number581477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: