Healthcare Provider Details

I. General information

NPI: 1033151808
Provider Name (Legal Business Name): MARINA YUMENA LUCINA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BROADWAY SUITE 2100
SACRAMENTO CA
95820-1527
US

IV. Provider business mailing address

7424 NORBECK WAY
SACRAMENTO CA
95824-4342
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-9750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number404560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: