Provider Demographics
NPI:1013603463
Name:TICAS, LUZ
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:TICAS
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 1:4688 HUNTINGTON DR S APT 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1954
Mailing Address - Country:US
Mailing Address - Phone:213-884-5974
Mailing Address - Fax:
Practice Address - Street 1:4688 HUNTINGTON DR S APT 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1954
Practice Address - Country:US
Practice Address - Phone:213-884-5974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula