MEDICARE: LUCIA MODESTI 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
1	207P00000X	Emergency Medicine Physician	341778	NY
2	207P00000X	Emergency Medicine Physician	256333	MA

General Provider Information

NPI Number	:	1720222466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIA MODESTI M.D.

Provider Business Mailing Address
First Line	:	7224 SHORELINE DR UNIT 178
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-4930
Country	:	US
Telephone Number	:	619-618-5277
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W ARBOR DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	619-543-6222
Fax Number	:

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

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	02/02/2026

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Directions to “ LUCIA MODESTI M.D.” Practice Location

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