Healthcare Provider Details

I. General information

NPI: 1003002957
Provider Name (Legal Business Name): SUZANNE LUCAS L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12821 N CAVE CREEK RD SUITE 101
PHOENIX AZ
85022-5862
US

IV. Provider business mailing address

12821 N CAVE CREEK RD SUITE 101
PHOENIX AZ
85022-5862
US

V. Phone/Fax

Practice location:
  • Phone: 602-404-8483
  • Fax: 602-493-2246
Mailing address:
  • Phone: 602-404-8483
  • Fax: 602-493-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0192
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: