Healthcare Provider Details

I. General information

NPI: 1538096276
Provider Name (Legal Business Name): LUCAS EDWARD CAMPBELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E OHIO AVE
ESCONDIDO CA
92025-3421
US

IV. Provider business mailing address

2404 F ST
SAN DIEGO CA
92102-2025
US

V. Phone/Fax

Practice location:
  • Phone: 619-613-1595
  • Fax:
Mailing address:
  • Phone: 619-493-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: