Provider Demographics
NPI:1568417616
Name:TARIN, LUCILA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCILA
Middle Name:
Last Name:TARIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 YORK BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2634
Mailing Address - Country:US
Mailing Address - Phone:323-255-5643
Mailing Address - Fax:323-254-2158
Practice Address - Street 1:5823 YORK BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-2634
Practice Address - Country:US
Practice Address - Phone:323-255-1575
Practice Address - Fax:323-255-8139
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A784180Medicaid
CA00A784180OtherBLUE SHIELD
GAP00193716OtherMEDICARE RAILROAD
CAWA78418AMedicare PIN
CAWA78418BMedicare PIN
CAH90481Medicare UPIN