Healthcare Provider Details

I. General information

NPI: 1700456126
Provider Name (Legal Business Name): NATALIE BRYANETTE LUCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1563
US

IV. Provider business mailing address

5609 FLEMING AVE
OAKLAND CA
94605-1127
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax: 415-750-6614
Mailing address:
  • Phone: 510-409-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04220498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: