Healthcare Provider Details

I. General information

NPI: 1154857886
Provider Name (Legal Business Name): NELLAB LUCAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

4501 GRIMES PL
ENCINO CA
91316-4366
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8026
  • Fax: 504-988-3971
Mailing address:
  • Phone: 805-418-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA172684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: