Provider Demographics
NPI:1518334895
Name:HULICK, MONIQUE (L AC)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:HULICK
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12747 LANTANA AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-3644
Mailing Address - Country:US
Mailing Address - Phone:408-603-8969
Mailing Address - Fax:
Practice Address - Street 1:12747 LANTANA AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-3644
Practice Address - Country:US
Practice Address - Phone:408-603-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16627171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist