Provider Demographics
NPI:1386926749
Name:LUCIA, BEVERLY ANN
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:LUCIA
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 1:26725 NEFF CT
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-6926
Mailing Address - Country:US
Mailing Address - Phone:661-313-5008
Mailing Address - Fax:
Practice Address - Street 1:26725 NEFF CT
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-6926
Practice Address - Country:US
Practice Address - Phone:661-298-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner