Healthcare Provider Details

I. General information

NPI: 1083846679
Provider Name (Legal Business Name): VINCENT A LUCY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

PO BOX 25490
HONOLULU HI
96825-0490
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-0300
  • Fax: 808-536-0320
Mailing address:
  • Phone: 808-536-0300
  • Fax: 808-536-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number12056
License Number StateHI

VIII. Authorized Official

Name: VINCENT A LUCY
Title or Position: OWNER
Credential: MD
Phone: 808-342-7792