Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G61884 | CA |
NPI | 1003918848 |
---|---|
Provider Name | Dr. Sara Josephine Richey-Lucero |
First Address | Martinez, CA 94553-3156 |
Second Address | Martinez, CA 94553-3156 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 18/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E64752 | (02) | CA |