Individual
GUINEVERE LUCIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1682 NOVATO BLVD STE 105, NOVATO, CA 94947-0001
(628) 253-8740
Mailing address
1682 NOVATO BLVD STE 105, NOVATO, CA 94947-0001
(628) 253-8740
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-CDNDGL
CA
175T00000X
Peer Specialist
—
—
Other
Enumeration date
05/24/2022
Last updated
11/04/2024
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