Individual
HILDA LICON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11234 ANDERSON ST, LOMA LINDA, CA 92354-2804
(909) 558-8173
Mailing address
10730 CHURCH ST, RANCHO CUCAMONGA, CA 91730-8953
(915) 765-9271
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
AP132500
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
95001895
CA
Other
Enumeration date
11/07/2016
Last updated
08/21/2023
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