MEDICARE: SA'DE C LUCIN-MARTIN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	247200000X	Other Technician
2	374700000X	Technician
3	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1588267967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SA'DE C LUCIN-MARTIN

Provider Business Mailing Address
First Line	:	150 BEL PORT DR UNIT 151
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-0175
Country	:	US
Telephone Number	:	916-254-9885
Fax Number	:

Provider Business Practice Location Address
First Line	:	2881 S VALLEY VIEW BLVD STE 4
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0170
Country	:	US
Telephone Number	:	702-852-6633
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	07/02/2024

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Directions to “ SA'DE C LUCIN-MARTIN ” Practice Location

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