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General NPI Number Information
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NPI Number | 1568852689
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Entity Type | Individual
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Provider Name | MARTIN HICKS
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Gender | Male
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 2500 WILSHIRE BLVD FL 5
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City | LOS ANGELES
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State | CA
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Zip | 90057-4303
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Country | US
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Telephone | 213-639-0230
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Fax | 213-365-2813
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Provider Business Mailing Address
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Address Line | 1552 W 49TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90062-2410
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Country | US
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Telephone | 323-293-7854
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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