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Organization
LICORISH MEDICAL CORPORATION
Active
Organization
LICORISH MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENRICK ANTHONY LICORISH M.D. (CEO)
(714) 523-3154
Entity
Organization
Contact information
Practice address
8803 GARDEN GROVE BLVD, GARDEN GROVE, CA 92844-1211
(714) 523-3154
(714) 523-4970
Mailing address
8803 GARDEN GROVE BLVD, GARDEN GROVE, CA 92844-1211
(714) 523-3154
(714) 523-4970
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
01/09/2007
Last updated
08/22/2020
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