Provider Demographics
NPI:1417712936
Name:SCALISE, LUCIA
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:SCALISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 16TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1119
Mailing Address - Country:US
Mailing Address - Phone:209-558-4595
Mailing Address - Fax:
Practice Address - Street 1:920 16TH ST STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1119
Practice Address - Country:US
Practice Address - Phone:209-558-4595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker