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NPI Code Detail

MEDICARE: DIANNE LUCIO

MEDICARE:   DIANNE  LUCIO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1578946505
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNE LUCIO
Provider Business Mailing Address
First Line : 650 E AZURE AVE APT 1035
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-6871
Country : US
Telephone Number : 770-374-5424
Fax Number :
Provider Business Practice Location Address
First Line : 3660 N RANCHO DR STE 113
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-3188
Country : US
Telephone Number : 702-982-2928
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2015
Last Update Date : 12/27/2016

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Directions to “ DIANNE LUCIO ” Practice Location

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