Provider Demographics
NPI:1700590569
Name:HAWKINS, MICO
Entity Type:Individual
Prefix:
First Name:MICO
Middle Name:
Last Name:HAWKINS
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 1:44616 FIG AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3415
Mailing Address - Country:US
Mailing Address - Phone:661-373-8792
Mailing Address - Fax:
Practice Address - Street 1:44616 FIG AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3415
Practice Address - Country:US
Practice Address - Phone:661-373-8792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347E00000XTransportation ServicesTransportation Broker
No374U00000XNursing Service Related ProvidersHome Health Aide
No251X00000XAgenciesSupports Brokerage
No332U00000XSuppliersHome Delivered Meals