Basic Information
| Provider Information | |||||||||
| NPI: | 1992969075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUECA VILLA | ||||||||
| FirstName: | LUCERO | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3345 BURNS RD | ||||||||
| Address2: | 302 | ||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334104324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616227661 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3345 BURNS RD | ||||||||
| Address2: | 302 | ||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334104324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616227661 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2008 | ||||||||
| LastUpdateDate: | 04/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301092988 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.