Healthcare Provider Details

I. General information

NPI: 1194969873
Provider Name (Legal Business Name): TERESA LORRAINE AUCK LUCIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA TALENS

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 WEST BEE CAVES ROAD SUITE M-302
AUSTIN TX
78746-5236
US

IV. Provider business mailing address

1004 SOUTH ROCK STREET
GEORGETOWN TX
78626
US

V. Phone/Fax

Practice location:
  • Phone: 512-697-3502
  • Fax: 512-697-3501
Mailing address:
  • Phone: 512-279-0348
  • Fax: 512-371-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberP6452
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: