MEDICARE: MIKA ELLA DIJAMCO LUCAS PA-C

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
1	363A00000X	Physician Assistant	PA66738	CA

General Provider Information

NPI Number	:	1942179577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKA ELLA DIJAMCO LUCAS PA-C

Provider Business Mailing Address
First Line	:	1081 MARKET PL STE 500
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-4750
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 MARKET PL STE 500
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-4750
Country	:	US
Telephone Number	:	669-235-4188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	01/19/2026

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