Provider Demographics
NPI:1144734906
Name:LUCIDITY SLEEP AND PSYCHIATRY
Entity type:Organization
Organization Name:LUCIDITY SLEEP AND PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMARCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-650-2290
Mailing Address - Street 1:450 S MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6674
Mailing Address - Country:US
Mailing Address - Phone:760-650-2290
Mailing Address - Fax:
Practice Address - Street 1:450 S MELROSE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6674
Practice Address - Country:US
Practice Address - Phone:760-650-2290
Practice Address - Fax:760-400-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160428972084S0012X
CAA1259032084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty