Provider Demographics
NPI:1669030987
Name:LUCASAN, DANAH MAJORIE FERNANDO (NP-C)
Entity type:Individual
Prefix:
First Name:DANAH MAJORIE
Middle Name:FERNANDO
Last Name:LUCASAN
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:DANAH
Other - Middle Name:FERNANDO
Other - Last Name:LUCASAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:15032 SAGEGROVE LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:461 TENNESSEE ST STE C
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8161
Practice Address - Country:US
Practice Address - Phone:909-477-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-01
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty