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1467857284
JACQUELINE LICAUCO
BURBANK, CA
NPI
1467857284
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: CA 95000859)
Enumeration Date
2014-10-23
Last Update Date
2019-08-06
Business Address
JACQUELINE LICAUCO NP
191 S BUENA VISTA SUITE 100
BURBANK, CA 91505-4554
Phone number: 818-869-7600
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Mailing Address
JACQUELINE LICAUCO NP
PO BOX 9602
MISSION HILLS, CA 91346-9602
Phone number: 818-837-5559
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