Provider Demographics
NPI:1184828659
Name:FICK, KIRSTEN HOPE (PA)
Entity Type:Individual
Prefix:PROF
First Name:KIRSTEN
Middle Name:HOPE
Last Name:FICK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MOJO CT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2334
Mailing Address - Country:US
Mailing Address - Phone:949-631-1867
Mailing Address - Fax:
Practice Address - Street 1:12556 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2006
Practice Address - Country:US
Practice Address - Phone:714-897-9355
Practice Address - Fax:714-897-5117
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18599363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMF1498105OtherDEA #
CAMF1498105OtherDEA #