Provider Demographics
NPI:1225183320
Name:LUCE, DAVID WILLIS (PHD, MT-BC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIS
Last Name:LUCE
Suffix:
Gender:M
Credentials:PHD, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 CHAMPION WAY APT 117
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1220
Mailing Address - Country:US
Mailing Address - Phone:714-417-9879
Mailing Address - Fax:
Practice Address - Street 1:2955 CHAMPION WAY APT 117
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1220
Practice Address - Country:US
Practice Address - Phone:714-417-9879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist