Individual
MS. JEAN MARIE LUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
33420 ROBINDR., GREEN VALLEY LAKE, CA 92341-8327
(909) 379-9894
Mailing address
PO BOX 8327, GREEN VALLEY LAKE, CA 92341-8327
(909) 379-9894
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
CAPA15505
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CAPA15505
—
CA
Enumeration date
02/13/2007
Last updated
07/09/2007
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