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General NPI Number Information
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NPI Number | 1932743366
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Entity Type | Individual
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Provider Name | PHILIP AMICK
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Gender | Male
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 716 PINOT NOIR DR
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City | LODI
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State | CA
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Zip | 95240-7408
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Country | US
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Telephone | 504-343-4092
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Fax |
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Provider Business Mailing Address
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Address Line | 2526 BANYAN DR
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City | LODI
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State | CA
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Zip | 95240-7104
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Country | US
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Telephone | 209-333-0139
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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