Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 19834 | CA |
NPI | 1831346329 |
---|---|
Provider Name | Dr. Randall Hicks |
First Address | Hayward, CA 94544-1058 |
Second Address | Hayward, CA 94544-1058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2008 |
Last Update Date | 26/08/2008 |