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NPI Code Detail

MEDICARE: GENTLE F LUCARIO HEADLEY LEWIS

MEDICARE: GENTLE F LUCARIO HEADLEY LEWIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164X00000XLicensed Vocational Nurse751764CA
2171M00000XCase Manager/Care CoordinatorCA

General Provider Information

NPI Number : 1376055145
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENTLE F LUCARIO HEADLEY LEWIS
Provider Business Mailing Address
First Line : 1774 ZONAL AVE BLDG C
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-1064
Country : US
Telephone Number : 310-221-6336
Fax Number :
Provider Business Practice Location Address
First Line : 1774 ZONAL AVE BLDG C
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-1064
Country : US
Telephone Number : 310-221-6336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2017
Last Update Date : 02/12/2026

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Directions to “ GENTLE F LUCARIO HEADLEY LEWIS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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