Healthcare Provider Details

I. General information

NPI: 1013275700
Provider Name (Legal Business Name): LUCIDO LUCIANO PONCE MEJIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 PERDIDO ST FL 8
NEW ORLEANS LA
70112-1352
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400 SUITE 400
LOS ANGELES CA
90095-5631
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-6120
  • Fax: 504-568-6127
Mailing address:
  • Phone: 310-301-8707
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number326367
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number326367
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number326367
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number326367
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number326367
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: