Healthcare Provider Details

I. General information

NPI: 1659365088
Provider Name (Legal Business Name): FRANK HENRY LUCIDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 DURANT AVE
BERKELEY CA
94704-1607
US

IV. Provider business mailing address

2300 DURANT AVE
BERKELEY CA
94704-1607
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-0958
  • Fax: 510-848-0961
Mailing address:
  • Phone: 510-848-0958
  • Fax: 510-848-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG31530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: