| Monique Hicks, | |
|
834 Polar Bear Cir, Galt, CA 95632-3074 | |
| (209) 425-1361 | |
| Not Available |
| Full Name | Monique Hicks |
|---|---|
| Gender | Female |
| Speciality | Marriage & Family Therapist |
| Location | 834 Polar Bear Cir, Galt, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437499746 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | 104839 (California) | Primary |
| Entity Name | Permanente Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710 |
| Mailing Address | Practice Location Address |
|---|---|
| Monique Hicks, 4719 Quail Lakes Dr Ste G471, Stockton, CA 95207-8140 Ph: (209) 425-1361 | Monique Hicks, 834 Polar Bear Cir, Galt, CA 95632-3074 Ph: (209) 425-1361 |
Kenneth Bryan Kelso, LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 845 Mccauley Way, Galt, CA 95632 Phone: 916-532-0074 | |
Ms. Rita P. Soria, Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 425 Pine St, Suite 2, Galt, CA 95632 Phone: 209-745-3101 Fax: 209-745-7539 | |
Salina Nicole Rodriguez, Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 603 C St Ste A, Galt, CA 95632 Phone: 916-716-1858 | |
Veronica Zendejas, Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 425 Pine St Ste 2, Galt, CA 95632 Phone: 209-745-3101 | |
Ariana Pantoja Perez, LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 1213 Wise Way, Galt, CA 95632 Phone: 831-594-2615 |