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General NPI Number Information
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NPI Number | 1417547910
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Entity Type | Organization
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Legal Business Name | LICE CLINIC SOLUTIONS, LLC.
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 2050 ARTESIA BLVD STE 103
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City | TORRANCE
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State | CA
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Zip | 90504-3067
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Country | US
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Telephone | 800-920-5423
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Fax |
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Provider Business Mailing Address
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Address Line | 952 BLUE HERON
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City | SEAL BEACH
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State | CA
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Zip | 90740-5612
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Country | US
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Telephone | 562-480-7236
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARLA YOHANA WEISS
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Credential | DNP
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Telephone | 562-480-7236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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