Provider Demographics
NPI:1073879722
Name:PICON, LETRICIA
Entity Type:Individual
Prefix:
First Name:LETRICIA
Middle Name:
Last Name:PICON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10012 NORWALK BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3362
Mailing Address - Country:US
Mailing Address - Phone:562-941-2537
Mailing Address - Fax:
Practice Address - Street 1:10012 NORWALK BLVD STE 140
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3362
Practice Address - Country:US
Practice Address - Phone:562-941-2537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner