Organization
LICE PATROL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROSE M MOORE (CFO)
(805) 668-2414
Entity
Organization
Contact information
Practice address
171 N 13TH ST, GROVER BEACH, CA 93433-2231
(805) 668-2414
Mailing address
171 N 13TH ST, GROVER BEACH, CA 93433-2231
(805) 668-2414
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
LCA761
UT
Other
Enumeration date
08/27/2018
Last updated
08/27/2018
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