Healthcare Provider Details

I. General information

NPI: 1780908111
Provider Name (Legal Business Name): NILDA OMAYRA LUCIANO M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2010
Last Update Date: 03/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 GONZALEZ CLEMENTE SUITE 104
MAYAGUEZ PUERTO RICO
00680
UM

IV. Provider business mailing address

P.O. BOX 1882
CABO ROJO PUERTO RICO
00623
UM

V. Phone/Fax

Practice location:
  • Phone: 787-216-9600
  • Fax: 787-851-6558
Mailing address:
  • Phone: 787-216-9600
  • Fax: 787-851-6558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9880
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: