Provider Demographics
NPI:1831167717
Name:LUCAS, RANDALL CARL (TECHNICIAN)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:CARL
Last Name:LUCAS
Suffix:
Gender:M
Credentials:TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 TOMALES RD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5002
Mailing Address - Country:US
Mailing Address - Phone:707-765-7200
Mailing Address - Fax:707-765-7521
Practice Address - Street 1:599 TOMALES RD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5002
Practice Address - Country:US
Practice Address - Phone:707-765-7200
Practice Address - Fax:707-765-7521
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other