Provider Demographics
NPI:1417547910
Name:LICE CLINIC SOLUTIONS, LLC.
Entity Type:Organization
Organization Name:LICE CLINIC SOLUTIONS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:YOHANA
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:562-480-7236
Mailing Address - Street 1:952 BLUE HERON
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5612
Mailing Address - Country:US
Mailing Address - Phone:562-480-7236
Mailing Address - Fax:
Practice Address - Street 1:2050 ARTESIA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-3067
Practice Address - Country:US
Practice Address - Phone:800-920-5423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care