Provider Demographics
NPI:1497835649
Name:BURCIAGA, LUCY (MD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:BURCIAGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 CORPORATE CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7760
Mailing Address - Country:US
Mailing Address - Phone:702-910-3950
Mailing Address - Fax:702-786-6650
Practice Address - Street 1:6296 E GRANT RD STE 140
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5876
Practice Address - Country:US
Practice Address - Phone:202-440-6005
Practice Address - Fax:520-867-6721
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ182678Medicaid
ASZ182678Medicare PIN