Provider Demographics
NPI:1821561572
Name:DZENAN LULIC, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DZENAN LULIC, M.D., A MEDICAL CORPORATION
Other - Org Name:CAL OAKS PRIMARY CARE/LUCALI AESTHETIC MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DZENAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LULIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-387-9817
Mailing Address - Street 1:40700 CALIFORNIA OAKS RD STE 206
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5789
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40700 CALIFORNIA OAKS RD STE 207
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5789
Practice Address - Country:US
Practice Address - Phone:951-387-9817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-05
Last Update Date:2022-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty