Provider Demographics
NPI:1225108533
Name:LUCCHESI, ARCHANA C (MD)
Entity Type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:C
Last Name:LUCCHESI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13280 EVENING CREEK DR S STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4109
Mailing Address - Country:US
Mailing Address - Phone:858-546-3800
Mailing Address - Fax:858-546-3900
Practice Address - Street 1:6729 MONTE RD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-8050
Practice Address - Country:US
Practice Address - Phone:858-546-3800
Practice Address - Fax:858-546-3900
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ379522085R0202X
ARE-142162085R0202X
CAG840842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G840840Medicaid
AZ426149Medicaid
CACH9716OtherCHAMPUS ID NUMBER
CAG84084OtherCAL LICENSE NUMBER
CAP00067109OtherRAILROAD MEDICARE
CAG84084OtherCAL LICENSE NUMBER
CAG66575Medicare UPIN
AZ426149Medicaid