Provider Demographics
NPI:1508116799
Name:CIFOR, LUCIA
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:CIFOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:G. C
Other - Middle Name:LUCIS
Other - Last Name:HOME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6309 PATTYPEART WAY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3455
Mailing Address - Country:US
Mailing Address - Phone:916-212-8133
Mailing Address - Fax:
Practice Address - Street 1:6309 PATTYPEART WAY
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3455
Practice Address - Country:US
Practice Address - Phone:916-212-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347001434310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility