Provider Demographics
NPI:1326367921
Name:LUCIO, DIANE G (RPSGT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:G
Last Name:LUCIO
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PERRIN CENTRAL BLVD
Mailing Address - Street 2:318
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-2794
Mailing Address - Country:US
Mailing Address - Phone:210-685-4077
Mailing Address - Fax:
Practice Address - Street 1:3800 PERRIN CENTRAL BLVD
Practice Address - Street 2:318
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2794
Practice Address - Country:US
Practice Address - Phone:210-685-4077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical