Provider Demographics
NPI:1588982342
Name:DEMARIS, LUCIEN (LAC,GCFP,NCTMB,CMT)
Entity type:Individual
Prefix:
First Name:LUCIEN
Middle Name:
Last Name:DEMARIS
Suffix:
Gender:M
Credentials:LAC,GCFP,NCTMB,CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10846 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3610
Mailing Address - Country:US
Mailing Address - Phone:310-367-8156
Mailing Address - Fax:310-559-7202
Practice Address - Street 1:10846 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3610
Practice Address - Country:US
Practice Address - Phone:310-367-8156
Practice Address - Fax:310-559-7202
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3920225700000X
226300000X, 174H00000X
CAAC 14077171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
No174H00000XOther Service ProvidersHealth Educator