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General NPI Number Information
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NPI Number | 1295836757
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Entity Type | Organization
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Legal Business Name | MARK HICKS
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 1280 W LAMBERT RD SUITE B
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City | BREA
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State | CA
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Zip | 92821-2820
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Country | US
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Telephone | 562-691-7161
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Fax | 562-691-7162
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Provider Business Mailing Address
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Address Line | 1280 W LAMBERT RD SUITE B
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City | BREA
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State | CA
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Zip | 92821-2820
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Country | US
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Telephone | 562-691-7161
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Fax | 562-691-7162
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARK P HICKS
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Credential | BS RRT RCP
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Telephone | 562-691-7161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 10079550
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License Number State | CA
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