| H. Randall Hicks, M.d. Inc, H Randall Hicks Pres | |
|
4060 Fourth Ave Suite 615 San Diego CA 92103-2116 | |
| (619) 298-7135 | |
| (858) 874-8837 |
| Full Name | H. Randall Hicks, M.d. Inc, H Randall Hicks Pres |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4060 Fourth Ave, San Diego, California |
| Authorized Official Name and Position | H. Randall Hicks (PRESIDENT & CEO) |
| Authorized Official Contact | 6192987135 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| H. Randall Hicks, M.d. Inc, H Randall Hicks Pres 4060 Fourth Ave Suite 615 San Diego CA 92103-2116 Ph: (619) 298-7135 | H. Randall Hicks, M.d. Inc, H Randall Hicks Pres 4060 Fourth Ave Suite 615 San Diego CA 92103-2116 Ph: (619) 298-7135 |
| NPI Number | 1497056386 |
|---|---|
| Provider Enumeration Date | 11/08/2010 |
| Last Update Date | 03/04/2014 |
| Medicare PECOS PAC ID | 5294922621 |
|---|---|
| Medicare Enrollment ID | O20101210000024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497056386 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | G47439 (California) | Primary |
| Provider Name | Howard Randall Hicks |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073628228 PECOS PAC ID: 7810184249 Enrollment ID: I20101210000039 |
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