1407016728 NPI number — LORI LINDA LUCIA MFT

Table of content: LORI LINDA LUCIA MFT (NPI 1407016728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407016728 NPI number — LORI LINDA LUCIA MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCIA
Provider First Name:
LORI
Provider Middle Name:
LINDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407016728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9770 ELMHURST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANITE BAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95746-7110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-671-4395
Provider Business Mailing Address Fax Number:
916-791-6503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8775 SIERRA COLLEGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-5985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-671-4395
Provider Business Practice Location Address Fax Number:
916-791-6503
Provider Enumeration Date:
06/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  50090 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)