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General NPI Number Information
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NPI Number | 1790703197
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Entity Type | Individual
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Provider Name | JESUS LUCAS M.D., PHD.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 915 N KING ST
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City | HONOLULU
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State | HI
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Zip | 96817-4544
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Country | US
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Telephone | 808-848-1438
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 E VISTA CHINO SUITE A7 # 262
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City | PALM SPRINGS
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State | CA
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Zip | 92262
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Country | US
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Telephone | 760-774-6442
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A76832
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD-22329
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License Number State | HI
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