Individual
ADRIAN LICON-CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
711 S NEW HAMPSHIRE AVE, LOS ANGELES, CA 90005-1831
(213) 385-5100
(323) 566-6722
Mailing address
1303 SANBORN AVE, LOS ANGELES, CA 90027-1509
(213) 385-5100
(323) 566-6722
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/26/2007
Last updated
08/01/2011
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