Provider Demographics
NPI:1376819227
Name:LUCAS, MONICA (PT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1578
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0578
Mailing Address - Country:US
Mailing Address - Phone:949-280-6703
Mailing Address - Fax:
Practice Address - Street 1:1441 SUPERIOR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2712
Practice Address - Country:US
Practice Address - Phone:949-646-0653
Practice Address - Fax:949-646-9228
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist