Healthcare Provider Details

I. General information

NPI: 1407791254
Provider Name (Legal Business Name): MARYCHA LUCIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. LAUREL ESQ. AVE. LOS MILLONES #100
BAYAMON PR
00986
US

IV. Provider business mailing address

AVE. LAUREL ESQ. AVE. LOS MILLONES #100
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-995-5200
  • Fax: 787-787-4343
Mailing address:
  • Phone: 787-995-5200
  • Fax: 787-787-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number101087
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: