Provider Demographics
NPI:1083212872
Name:LUCCIN, WEBSTER
Entity Type:Individual
Prefix:MR
First Name:WEBSTER
Middle Name:
Last Name:LUCCIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 S CONGRESS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4725
Mailing Address - Country:US
Mailing Address - Phone:561-577-1293
Mailing Address - Fax:
Practice Address - Street 1:4175 S CONGRESS AVE STE B
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-4725
Practice Address - Country:US
Practice Address - Phone:561-577-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver