Provider Demographics
NPI:1073187373
Name:LUCIO, AMARIS (AA)
Entity Type:Individual
Prefix:MS
First Name:AMARIS
Middle Name:
Last Name:LUCIO
Suffix:
Gender:F
Credentials:AA
Other - Prefix:MS
Other - First Name:AMARIS
Other - Middle Name:
Other - Last Name:LUCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:7226 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2003
Mailing Address - Country:US
Mailing Address - Phone:818-235-1414
Mailing Address - Fax:
Practice Address - Street 1:3311 CORDOVA AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-8974
Practice Address - Country:US
Practice Address - Phone:559-417-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician