WADE K.C. LICUP

VISTA, CA
NPI1881157998
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy207Q00000X Family Medicine
(Licence: CA  A179911)
Enumeration Date2019-04-08
Last Update Date2023-04-28
Business Address
Dr. WADE K.C. LICUP MD
130 CEDAR RD
VISTA, CA 92083-5102
Phone number: 760-806-5500
Mailing Address
Dr. WADE K.C. LICUP MD
10790 RANCHO BERNARDO RD
SAN DIEGO, CA 92127-5705
Phone number: 760-806-5500
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