Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 28257 | CA |
NPI | 1083758239 |
---|---|
Provider Name | Dr. Vernell Deshan Lucas |
First Address | Paramount, CA 90723-2692 |
Second Address | Paramount, CA 90723-6153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 29/04/2009 |