Provider Demographics
NPI:1710535505
Name:LAWRENCE, LUCILLE ARSUA
Entity Type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:ARSUA
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LUCILLE
Other - Middle Name:ARSUA
Other - Last Name:STALLWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:733 SKIMMER DR
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-8735
Mailing Address - Country:US
Mailing Address - Phone:519-717-0063
Mailing Address - Fax:
Practice Address - Street 1:3014 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-3212
Practice Address - Country:US
Practice Address - Phone:510-698-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKK375277174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty