Provider Demographics
NPI:1013072057
Name:HICKS, CHRISTINA (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 N LAKE RD
Mailing Address - Street 2:H. RAJENDER REDDY HEALTH CENTER
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95343-5001
Mailing Address - Country:US
Mailing Address - Phone:209-228-4581
Mailing Address - Fax:
Practice Address - Street 1:5200 N LAKE RD
Practice Address - Street 2:H. RAJENDER REDDY HEALTH CENTER
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95343-5001
Practice Address - Country:US
Practice Address - Phone:209-228-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17598363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant