Individual
CRISTY LICON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2085 RUSTIN AVE, RIVERSIDE, CA 92507-2498
(951) 955-7320
Mailing address
16283 STARVIEW ST, MORENO VALLEY, CA 92551-7215
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
246340
CA
Other
Enumeration date
03/01/2022
Last updated
03/01/2022
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