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NPI Code Detail

MEDICARE: LACEY POPICHAK

MEDICARE: LACEY POPICHAK
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
1225XP0019XPhysical Rehabilitation Occupational Therapist19322CA

General Provider Information

NPI Number : 1639640337
Entity Type Code : Individual
Provider Name (Legal Business Name) : LACEY POPICHAK
Provider Business Mailing Address
First Line : 191 DUBOCE AVE APT 203
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94103-1167
Country : US
Telephone Number : 831-235-1859
Fax Number :
Provider Business Practice Location Address
First Line : 3400 LAGUNA ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94123-2271
Country : US
Telephone Number : 415-202-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2018
Last Update Date : 12/06/2018

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Directions to “ LACEY POPICHAK ” Practice Location

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