Healthcare Provider Details

I. General information

NPI: 1770345589
Provider Name (Legal Business Name): LICET CAROLINA HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LICET CAROLINA MUNOZ VASQUEZ

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E BROAD ST
RICHMOND VA
23219-1930
US

IV. Provider business mailing address

3409 MARWICK PLACER
RICHMOND VA
23234
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9095
  • Fax:
Mailing address:
  • Phone: 843-949-7704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420081
License Number StateVA
# 2
Primary TaxonomyN
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: