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NPI Code Detail

MEDICARE: ALICIA MARIE LACEY

MEDICARE: ALICIA MARIE LACEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13747A0650XAttendant Care Provider

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A6742059OTHERCADRIVER LICENSE

General Provider Information

NPI Number : 1679113856
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA MARIE LACEY
Provider Business Mailing Address
First Line : 516 S HORNE ST
Second Line :
City : OCEANSIDE
State : CA
Zip : 92054-4251
Country : US
Telephone Number : 760-420-4669
Fax Number :
Provider Business Practice Location Address
First Line : 2325 CALIFORNIA ST
Second Line :
City : OCEANSIDE
State : CA
Zip : 92054-5711
Country : US
Telephone Number : 760-212-1919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2020
Last Update Date : 01/15/2020

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Directions to “ ALICIA MARIE LACEY ” Practice Location

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