MEDICARE: LUCZAL SS

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1780266064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCZAL SS

Provider Business Mailing Address
First Line	:	PO BOX 2166
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77487-2166
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Provider Business Practice Location Address
First Line	:	17007 IRISH OAKS CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5884
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Authorized Official
Title or Position	:	OWNER
Name	:	LUCIO ZALDANA
Credential	:	LSA
Telephone Number	:	832-875-8410

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	04/26/2021

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