Individual
MICHAEL PAUL LICHT II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4309 3RD AVE, SAN DIEGO, CA 92103-1407
(619) 876-4502
Mailing address
3825 47TH ST APT 6, SAN DIEGO, CA 92105-2863
(858) 952-8295
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
95114434
CA
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95114434
CA
Other
Enumeration date
03/26/2018
Last updated
03/26/2018
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