Healthcare Provider Details

I. General information

NPI: 1003091117
Provider Name (Legal Business Name): RALPH JOHN LUCIANI I D.O., M.D.(H)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 W GLENDALE AVE SUITE 106
PHOENIX AZ
85021-8578
US

IV. Provider business mailing address

1530 W GLENDALE AVE SUITE 106
PHOENIX AZ
85021-8578
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-4024
  • Fax: 602-242-4913
Mailing address:
  • Phone: 602-242-4024
  • Fax: 602-242-4913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number1080
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: