Provider Demographics
NPI:1255466603
Name:LOCKEN, EUGENE D (DO)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:D
Last Name:LOCKEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10131 CONCORD DRIVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:805-291-3229
Mailing Address - Fax:805-733-2222
Practice Address - Street 1:10131 CONCORD DRIVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:805-291-3229
Practice Address - Fax:805-733-2222
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE08742Medicare UPIN
W20A4208AMedicare ID - Type Unspecified