Healthcare Provider Details

I. General information

NPI: 1427828995
Provider Name (Legal Business Name): LUCIDSOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 W SUNSET RD
LAS VEGAS NV
89148-4844
US

IV. Provider business mailing address

100 E CAMPUS VIEW BLVD STE 100
COLUMBUS OH
43235-8628
US

V. Phone/Fax

Practice location:
  • Phone: 614-325-8899
  • Fax:
Mailing address:
  • Phone: 614-325-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK ALFONSO
Title or Position: PRESIDENT
Credential: MD
Phone: 614-396-4739