Provider Demographics
NPI:1023833373
Name:LUNICHKIN, ROMAN
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:LUNICHKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6863 TROVITA WAY
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-4662
Mailing Address - Country:US
Mailing Address - Phone:916-940-5894
Mailing Address - Fax:
Practice Address - Street 1:6863 TROVITA WAY
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-4662
Practice Address - Country:US
Practice Address - Phone:916-940-5894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker