MEDICARE: LAUREN DILUCA LAT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	RTO000472	PA

General Provider Information

NPI Number	:	1134750912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN DILUCA LAT, ATC

Provider Business Mailing Address
First Line	:	250 UNIVERSITY AVE
Second Line	:
City	:	CALIFORNIA
State	:	PA
Zip	:	15419-1341
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 WOODROW ST
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15133-2416
Country	:	US
Telephone Number	:	412-992-0670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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