MEDICARE: STACIA CAITLYN HICKEY MD

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1861335747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIA CAITLYN HICKEY MD

Provider Business Mailing Address
First Line	:	8700 BEVERLY BLVD STE 3636
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1804
Country	:	US
Telephone Number	:	310-423-7417
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 BEVERLY BLVD STE 3634
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1804
Country	:	US
Telephone Number	:	310-423-7417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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