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NPI Code Detail

MEDICARE: LUCILA QUINTO VILLALUZ M.D.

MEDICARE: LUCILA QUINTO VILLALUZ M.D.
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
12084P0800XPsychiatry PhysicianMD055156-LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1018606OTHERPAAMERIHEALTH 65 COMPLETE
2G80233OTHERPAMAGELLAN BEHAVIORAL HEALT
3018606OTHERPAGATEWAY 65 COMPLETE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346380128
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCILA QUINTO VILLALUZ M.D.
Provider Business Mailing Address
First Line : PO BOX 5349
Second Line :
City : BETHLEHEM
State : PA
Zip : 18015-0349
Country : US
Telephone Number : 484-221-9136
Fax Number : 484-221-9130
Provider Business Practice Location Address
First Line : 865 E 4TH ST
Second Line :
City : BETHLEHEM
State : PA
Zip : 18015-1935
Country : US
Telephone Number : 670-691-4357
Fax Number : 484-221-9130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2007
Last Update Date : 09/18/2015

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