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General NPI Number Information
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NPI Number | 1649512575
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Entity Type | Individual
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Provider Name | MICHAEL C LUCIANO M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/18/2013
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 3120 CHICAGO AVE SUITE #170
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City | RIVERSIDE
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State | CA
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Zip | 92507-3490
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Country | US
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Telephone | 714-547-4070
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Fax | 714-547-1388
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Provider Business Mailing Address
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Address Line | 8502 E CHAPMAN AVE SUITE #391
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City | ORANGE
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State | CA
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Zip | 92869-2461
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Country | US
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Telephone |
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Fax | 714-547-1388
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | A33713
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License Number State | CA
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