Healthcare Provider Details

I. General information

NPI: 1518334895
Provider Name (Legal Business Name): MONIQUE HULICK L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12747 LANTANA AVE
SARATOGA CA
95070-3644
US

IV. Provider business mailing address

12747 LANTANA AVE
SARATOGA CA
95070-3644
US

V. Phone/Fax

Practice location:
  • Phone: 408-603-8969
  • Fax:
Mailing address:
  • Phone: 408-603-8969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: