Healthcare Provider Details

I. General information

NPI: 1831193408
Provider Name (Legal Business Name): DAVID P LUSK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N HERITAGE DR BLDG A
RIDGECREST CA
93555-5536
US

IV. Provider business mailing address

900 N HERITAGE DR BLDG A
RIDGECREST CA
93555-5536
US

V. Phone/Fax

Practice location:
  • Phone: 760-446-4571
  • Fax: 760-446-0970
Mailing address:
  • Phone: 760-446-4571
  • Fax: 760-446-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG57066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: