Healthcare Provider Details

I. General information

NPI: 1588982342
Provider Name (Legal Business Name): LUCIEN DEMARIS LAC,GCFP,NCTMB,CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10846 WASHINGTON BLVD
CULVER CITY CA
90232-3610
US

IV. Provider business mailing address

10846 WASHINGTON BLVD
CULVER CITY CA
90232-3610
US

V. Phone/Fax

Practice location:
  • Phone: 310-367-8156
  • Fax: 310-559-7202
Mailing address:
  • Phone: 310-367-8156
  • Fax: 310-559-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3920
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 14077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: