Healthcare Provider Details

I. General information

NPI: 1326367921
Provider Name (Legal Business Name): DIANE G LUCIO RPSGT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PERRIN CENTRAL BLVD 318
SAN ANTONIO TX
78217-2794
US

IV. Provider business mailing address

3800 PERRIN CENTRAL BLVD 318
SAN ANTONIO TX
78217-2794
US

V. Phone/Fax

Practice location:
  • Phone: 210-685-4077
  • Fax:
Mailing address:
  • Phone: 210-685-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: