NPI 1003432667

John Henry Martin Lico

Practitioner Assisted Living Facility Surprise, AZ

Practice location

Address: 15244 W Watson Ln, Surprise, AZ 85379-7040
Phone: (623) 227-9697

Registered specialties

Assisted Living Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310400000X Licence AL11496H (AZ)

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Registry record

NPI: 1003432667
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Jun 2020
Record last updated: 19 Jun 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.