JACQUELINE LICAUCO (NPI# 1467857284) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467857284 |
| Entity Type | Individual |
| Full Name | JACQUELINE LICAUCO |
| Credential | NP |
| Practice Address |
191 S Buena Vista Suite 100 Burbank CA 91505-4554 |
| Mailing Address |
Po Box 9602 Mission Hills CA 91346-9602 |
| Practice Telephone | 8188697600 |
| Practice Fax Number | 8144333691 |
| Mailing Telephone | 8188375559 |
| Mailing Fax Number | 8187924793 |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2019-08-06 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
95000859 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
191 S BUENA VISTA SUITE 100 |
| City | BURBANK |
| State | CA |
| Zip Code | 91505-4554 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336670025 | Sreeramya Kanumilli | Pediatrics | 191 S Buena Vista, Suite 100, Burbank, CA 91505-4562 | 2017-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023625035 | K and S Hospice Inc | Hospice Care, Community Based | 4100 W Alameda Ave Fl 3, Burbank, CA 91505 | 2020-09-24 |
| 1013542471 | Jami Stehlin | Nurse Practitioner | 501 S. Buena Vista St. 3ne, Burbank, CA 91505 | 2020-03-06 |
| 1497309033 | Ibrahim Lala | Pharmacist | 181 S. Buena Vista St, Burbank, CA 91505 | 2019-08-01 |
| 1720501240 | Jung H Li | Registered Nurse | Psjmc- Bariatric Wellness Center, 501 S Buena Vista St, Burbank, CA 91505 | 2017-07-18 |
| 1699204974 | Beth Ellen Izbotsky | Physical Medicine & Rehabilitation | 501 S Buena Vista Blvd, Burbank, CA 91505 | 2017-06-08 |
| 1205387446 | Fabiola Bachman | Dentist | 138 N Pass Ave, 2, Burbank, CA 91505 | 2016-10-24 |
| 1114478203 | Marianna Ghularyan D.d.s. Inc | Dentist | 1400 N. Edison Blvd., Burbank, CA 91505 | 2016-10-24 |
| 1962952127 | Landa Mizin Dental Partnership | Dentist | 2625 W Alameda Ave Ste 502, Burbank, CA 91505 | 2016-10-11 |
| 1285183376 | Amy Di Francia | Marriage & Family Therapist | 4421 W Riverside Dr Ste 210, Burbank, CA 91505 | 2016-09-29 |
| 1306238381 | Abigail Merrin | Physical Therapist | 2701 W Alameda Ave Ste 206, Burbank, CA 91505 | 2015-02-26 |
| Find all providers in zip 91505 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437797347 | Erickson Dizon Liwag | Nurse Practitioner | 500 N 6th St Apt G, Burbank, CA 91501-3203 | 2019-12-11 |
| 1093373334 | Renato Patiag | Nurse Practitioner | 2701 W Alameda Ave Ste 200, Burbank, CA 91505-4406 | 2019-06-02 |
| 1013473511 | Lynn Adora Lima | Nurse Practitioner | Minute Clinic 9795 Burbank, 511 N Hollywood Way, Burbank, CA 91505-3406 | 2019-02-20 |
| 1659843522 | Tiffany Mae Guerra Herrera | Nurse Practitioner | 201 S Buena Vista St Ste 425, Burbank, CA 91505-4571 | 2018-12-17 |
| 1689141483 | Vadim Danielian | Nurse Practitioner | 9439 Via Venezia, Burbank, CA 91504-1244 | 2018-10-30 |
| 1497264782 | Cara Lyn Mcguire | Nurse Practitioner | 4901 W 79th St Ste 2/3, Burbank, IL 60459-1554 | 2017-09-29 |
| 1073041182 | Cecilia Veronica Estrada | Nurse Practitioner | 1438 N Avon St, Burbank, CA 91505-1817 | 2017-06-02 |
| 1396295325 | Mark Vincent Olivarez | Nurse Practitioner | 1817 N Kenwood St, Burbank, CA 91505-1418 | 2016-10-14 |
| 1376988899 | Arlene Torres Fabian | Nurse Practitioner | 1825 N Avon St, Burbank, CA 91505-1506 | 2013-05-10 |
| 1285078097 | Arlene Lee | Nurse Practitioner | 2625 W Alameda Ave Ste 506, Burbank, CA 91505-4816 | 2013-04-23 |
| Find all providers in BURBANK | ||||
Please comment or provide details below to improve the information on JACQUELINE LICAUCO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.