Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | ||
Y | 176B00000X | Midwife | LM 155 | CA |
NPI | 1114049624 |
---|---|
Provider Name | Ms. Marla Karel Hicks |
First Address | La Mesa, CA 91941-6435 |
Second Address | San Diego, CA 92105-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 14/01/2011 |