Individual
ELIZABETH C KICKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
WHNP, CNM, PHN
Contact information
Practice address
4514 38TH STREET, SAN DIEGO, CA 92105-1108
(760) 889-0774
Mailing address
4514 38TH STREET, SAN DIEGO, CA 92105-1108
(760) 889-0774
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
95001452
CA
367A00000X
Advanced Practice Midwife
235680
CA
Other
Enumeration date
11/13/2014
Last updated
11/13/2014
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