Individual
LIESEL ALLISON LUCAS BACANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4301 X ST, SACRAMENTO, CA 95817-2214
(916) 731-2011
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 453-5200
(559) 453-5233
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
67198
CA
363AS0400X
Surgical Physician Assistant
Primary
67198
CA
Other
Enumeration date
03/14/2025
Last updated
01/02/2026
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