Healthcare Provider Details

I. General information

NPI: 1952537326
Provider Name (Legal Business Name): SARAH PRADKA LUCAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH PHYLLIS PRADKA MD

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 410
LA JOLLA CA
92037-1212
US

IV. Provider business mailing address

9850 GENESEE AVE STE 410
LA JOLLA CA
92037-1212
US

V. Phone/Fax

Practice location:
  • Phone: 858-550-0330
  • Fax: 858-550-0676
Mailing address:
  • Phone: 858-550-0330
  • Fax: 858-550-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2015-01246
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA155280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: