Healthcare Provider Details

I. General information

NPI: 1386305472
Provider Name (Legal Business Name): KENDALL MARIE LUCARA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2022
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR # MC7723
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

9175 JUDICIAL DR APT 6501
SAN DIEGO CA
92122-4681
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-5966
  • Fax:
Mailing address:
  • Phone: 406-696-2453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: