Healthcare Provider Details

I. General information

NPI: 1356220925
Provider Name (Legal Business Name): HALEY FICK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20011 VENTURA BLVD
WOODLAND HILLS CA
91364-2573
US

IV. Provider business mailing address

15259 MONROE AVE
MOORPARK CA
93021-3219
US

V. Phone/Fax

Practice location:
  • Phone: 818-528-5525
  • Fax:
Mailing address:
  • Phone: 805-405-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: