Provider Demographics
NPI:1295417376
Name:KORICK, ADAM AMES
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:AMES
Last Name:KORICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5533 TRAIL ST
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2489
Mailing Address - Country:US
Mailing Address - Phone:951-258-3768
Mailing Address - Fax:
Practice Address - Street 1:5533 TRAIL ST
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2489
Practice Address - Country:US
Practice Address - Phone:951-258-3768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95185793163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse