Provider Demographics
NPI:1306317649
Name:LALUCIS, JACQUELINE R
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:R
Last Name:LALUCIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 CAMINO PLAZA, SAN BRUNO, CA 94066
Mailing Address - Street 2:A
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066
Mailing Address - Country:US
Mailing Address - Phone:650-627-8045
Mailing Address - Fax:
Practice Address - Street 1:751 CAMINO PLAZA, SAN BRUNO, CA 94066
Practice Address - Street 2:A
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066
Practice Address - Country:US
Practice Address - Phone:650-627-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician