Provider Demographics
NPI:1093603458
Name:TAKATA PONTES ARRUDA, LUCIANA (MD, MSC)
Entity type:Individual
Prefix:DR
First Name:LUCIANA
Middle Name:
Last Name:TAKATA PONTES ARRUDA
Suffix:
Gender:F
Credentials:MD, MSC
Other - Prefix:DR
Other - First Name:LUCIANA
Other - Middle Name:
Other - Last Name:TAKATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MSC
Mailing Address - Street 1:PO BOX 919832
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9832
Mailing Address - Country:US
Mailing Address - Phone:561-748-0510
Mailing Address - Fax:561-748-0598
Practice Address - Street 1:2101 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-7321
Practice Address - Country:US
Practice Address - Phone:561-748-0510
Practice Address - Fax:561-748-0598
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME175350207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology