Provider Demographics
NPI:1689331126
Name:LUCACI, BIANCA (NP-C)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:LUCACI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29826 HAUN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-6547
Mailing Address - Country:US
Mailing Address - Phone:951-679-7022
Mailing Address - Fax:888-379-6223
Practice Address - Street 1:29826 HAUN RD STE 300
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6547
Practice Address - Country:US
Practice Address - Phone:951-679-7022
Practice Address - Fax:888-379-6223
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015561363LA2200X, 363LP2300X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner