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General NPI Number Information
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NPI Number | 1912488933
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Entity Type | Organization
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Legal Business Name | LICE PATROL INC
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 171 N 13TH ST
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City | GROVER BEACH
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State | CA
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Zip | 93433-2231
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Country | US
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Telephone | 805-668-2414
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Fax |
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Provider Business Mailing Address
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Address Line | 171 N 13TH ST
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City | GROVER BEACH
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State | CA
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Zip | 93433-2231
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Country | US
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Telephone | 805-668-2414
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. ROSE M MOORE
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Credential |
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Telephone | 805-668-2414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | LCA761
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License Number State | UT
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