Healthcare Provider Details

I. General information

NPI: 1548350721
Provider Name (Legal Business Name): LUCIANO PUCCIO HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. 65 INFANTERY CARR. #3 KM 8.3
CAROLINA PR
00984
US

IV. Provider business mailing address

PO BOX 1756
TRUJILLO ALTO PR
00977-1756
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-1800
  • Fax:
Mailing address:
  • Phone: 787-349-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7335
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: