Provider Demographics
NPI:1114049624
Name:HICKS, MARLA KAREL (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:KAREL
Last Name:HICKS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 LA MESA BLVD # 143
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6435
Mailing Address - Country:US
Mailing Address - Phone:619-825-5590
Mailing Address - Fax:619-741-7053
Practice Address - Street 1:4135 54TH PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-2303
Practice Address - Country:US
Practice Address - Phone:619-825-5590
Practice Address - Fax:619-741-7053
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292568171M00000X
175L00000X
CALM 155176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175L00000XOther Service ProvidersHomeopath