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General NPI Number Information
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NPI Number | 1235843467
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Entity Type | Individual
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Provider Name | YACUB LUCAS
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Gender | Male
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 974 PARK RANCH WAY
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City | SACRAMENTO
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State | CA
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Zip | 95831-3064
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Country | US
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Telephone | 916-997-9130
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Fax | 916-515-8013
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Provider Business Mailing Address
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Address Line | 974 PARK RANCH WAY
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City | SACRAMENTO
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State | CA
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Zip | 95831-3064
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Country | US
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Telephone | 916-997-9130
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 6051257740
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License Number State | CA
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