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General NPI Number Information
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NPI Number | 1366494585
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Entity Type | Individual
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Provider Name | VIRGINIA P LUCES M.D
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Gender | Female
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 2050 LARKIN AVE SUITE 101
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City | ELGIN
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State | IL
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Zip | 60123-4405
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Country | US
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Telephone | 847-742-9698
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Fax | 847-742-9743
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Provider Business Mailing Address
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Address Line | 2050 LARKIN AVE SUITE 101
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City | ELGIN
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State | IL
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Zip | 60123-4405
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Country | US
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Telephone | 847-742-9698
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Fax | 847-742-9743
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 336026758
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036-062230
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License Number State | IL
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