Provider Demographics
NPI:1720798762
Name:CAMPBELL, LUCIA BRITT
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:BRITT
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4731 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1128
Mailing Address - Country:US
Mailing Address - Phone:510-973-9636
Mailing Address - Fax:
Practice Address - Street 1:1909 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1023
Practice Address - Country:US
Practice Address - Phone:510-809-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program