Provider Demographics
NPI:1790210540
Name:LUCE, DAMARA KATHLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:DAMARA
Middle Name:KATHLEEN
Last Name:LUCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4221
Mailing Address - Country:US
Mailing Address - Phone:510-365-1207
Mailing Address - Fax:
Practice Address - Street 1:1515 FAIRVIEW ST
Practice Address - Street 2:APT. C
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2317
Practice Address - Country:US
Practice Address - Phone:510-365-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54385363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant