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General NPI Number Information
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NPI Number | 1689483869
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Entity Type | Individual
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Provider Name | THERESA DIANE HICKS
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Gender | Female
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 49774 ROAD 426 STE D
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City | OAKHURST
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State | CA
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Zip | 93644-8691
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Country | US
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Telephone | 559-395-0453
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Fax | 559-683-6499
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Provider Business Mailing Address
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Address Line | 5028 W HERNDON AVE APT 101
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City | FRESNO
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State | CA
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Zip | 93722-8431
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Country | US
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Telephone | 559-722-4766
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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