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MS. JEAN MARIE LUCK P.A.

Medical >> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1740322619

Individual Registrant:
MS. JEAN MARIE LUCK P.A.
Gender: F
Sole Proprietor

Location and contact information for practice:
33420 ROBINDR.  GREEN VALLEY LAKE, CA 92341-8327 US
Tel: 909-379-9894  Fax: --

Contact information for business:
PO BOX 8327  GREEN VALLEY LAKE, CA 92341-8327 US
Tel: 909-379-9894  Fax: --

Registration Information:
NPI: 1740322619
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363AM0700XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Medical
CACAPA15505

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
CAPA15505CA05




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