Healthcare Provider Details

I. General information

NPI: 1154402097
Provider Name (Legal Business Name): BOCA PEDIATRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5458 TOWN CENTER RD STE 20
BOCA RATON FL
33486-1009
US

IV. Provider business mailing address

5458 TOWN CENTER RD STE 20
BOCA RATON FL
33486-1009
US

V. Phone/Fax

Practice location:
  • Phone: 561-391-6210
  • Fax: 561-391-2810
Mailing address:
  • Phone: 561-391-6210
  • Fax: 561-391-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERTO LUCHTAN
Title or Position: OWNER
Credential: MD
Phone: 561-368-4635