Provider Demographics
NPI:1528211885
Name:MONTALVO-HICKS, LUCY D (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:D
Last Name:MONTALVO-HICKS
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 ANZA AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4516
Mailing Address - Country:US
Mailing Address - Phone:858-243-2612
Mailing Address - Fax:760-945-9441
Practice Address - Street 1:4355 RUFFIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4306
Practice Address - Country:US
Practice Address - Phone:858-576-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43562080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities