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NPI Code Detail

MEDICARE: ALIVIA M LUCCI RN, PHN

MEDICARE: ALIVIA M LUCCI RN, PHN
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
1163W00000XRegistered Nurse743013CA

General Provider Information

NPI Number : 1740524669
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALIVIA M LUCCI RN, PHN
Provider Business Mailing Address
First Line : 111B SHOTWELL ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94103-5313
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 111B SHOTWELL ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94103-5313
Country : US
Telephone Number : 415-309-4209
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2012
Last Update Date : 11/15/2012

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