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NPI Code Detail

MEDICARE: LIESEL ALLISON LUCAS BACANI

MEDICARE: LIESEL ALLISON LUCAS BACANI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant67198CA
2363AS0400XSurgical Physician Assistant67198CA

General Provider Information

NPI Number : 1205636883
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIESEL ALLISON LUCAS BACANI
Provider Business Mailing Address
First Line : 2625 E DIVISADERO ST
Second Line :
City : FRESNO
State : CA
Zip : 93721-1431
Country : US
Telephone Number : 559-453-5200
Fax Number : 559-453-5233
Provider Business Practice Location Address
First Line : 4301 X ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95817-2214
Country : US
Telephone Number : 916-731-2011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2025
Last Update Date : 01/02/2026

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Directions to “ LIESEL ALLISON LUCAS BACANI ” Practice Location

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