Basic Information
| Provider Information | |||||||||
| NPI: | 1740335652 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LUCIANOS URGENT CARE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3360 COUNTY ROAD 220 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320684359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042912221 | ||||||||
| FaxNumber: | 9042826332 | ||||||||
| Practice Location | |||||||||
| Address1: | 3360 COUNTY ROAD 220 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320684359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042912221 | ||||||||
| FaxNumber: | 9042826332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LUCIANO | ||||||||
| AuthorizedOfficialFirstName: | CRISTINA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 9042912221 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME0074563 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.