Provider Demographics
NPI:1659812758
Name:LICE CLINICS OF AMERICA FREMONT
Entity Type:Organization
Organization Name:LICE CLINICS OF AMERICA FREMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-770-4394
Mailing Address - Street 1:39237 LIBERTY ST STE D-2
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1501
Mailing Address - Country:US
Mailing Address - Phone:510-770-4394
Mailing Address - Fax:
Practice Address - Street 1:39237 LIBERTY ST STE D-2
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1501
Practice Address - Country:US
Practice Address - Phone:510-770-4394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty