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General NPI Number Information
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NPI Number | 1457568081
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Entity Type | Individual
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Provider Name | CASS MICHAELA HICKS L.AC.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1905 UNION ST SUITE 4
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City | SAN FRANCISCO
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State | CA
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Zip | 94123-4237
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Country | US
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Telephone | 415-289-6531
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1036 2 OPAL ROAD
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City | BOLINAS
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State | CA
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Zip | 94924-1036
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Country | US
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Telephone | 415-868-8816
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 4943
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License Number State | CA
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