1841424066 NPI number — DR. LUCIA CAROL CARGILL PHD, MSN, FNP-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841424066 NPI number — DR. LUCIA CAROL CARGILL PHD, MSN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARGILL
Provider First Name:
LUCIA
Provider Middle Name:
CAROL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, MSN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROLLINS
Provider Other First Name:
LUCIA
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSN, RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841424066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SEQUOIA MIND HEALTH
Provider Second Line Business Mailing Address:
1506 4TH ST.
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-527-1315
Provider Business Mailing Address Fax Number:
707-527-1307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SEQUOIA MIND HEALTH
Provider Second Line Business Practice Location Address:
1506 4TH ST
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-527-1315
Provider Business Practice Location Address Fax Number:
707-527-1307
Provider Enumeration Date:
05/04/2009

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: 363LF0000X , with the licence number:  RN197365 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: NP18603 , 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)





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