Provider Demographics
NPI:1558933283
Name:HAICK, ANGELA CARMEL
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CARMEL
Last Name:HAICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11637 REGIO CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1370
Mailing Address - Country:US
Mailing Address - Phone:510-978-3599
Mailing Address - Fax:
Practice Address - Street 1:39155 LIBERTY ST # 500
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1513
Practice Address - Country:US
Practice Address - Phone:510-574-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program