Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | G72884 | CA |
N | 2080P0204X | Pediatric Emergency Doctor | G72884 | CA |
NPI | 1306917158 |
---|---|
Provider Name | Simon Joseph Lucio |
First Address | San Diego, CA 92123-4800 |
Second Address | San Diego, CA 92123-4223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G728840 | (05) | CA |
F70818 | (02) | CA |