MEDICARE: DIANE G LUCIO RPSGT

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	246ZA2600X	Medical Art Specialist/Technologist

General Provider Information

NPI Number	:	1326367921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE G LUCIO RPSGT

Provider Business Mailing Address
First Line	:	3800 PERRIN CENTRAL BLVD
Second Line	:	318
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-2794
Country	:	US
Telephone Number	:	210-685-4077
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 PERRIN CENTRAL BLVD
Second Line	:	318
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-2794
Country	:	US
Telephone Number	:	210-685-4077
Fax Number	:

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

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	05/21/2010

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