Provider Demographics
NPI:1558131128
Name:ATAIDE, LUCILDA MARIA
Entity Type:Individual
Prefix:
First Name:LUCILDA
Middle Name:MARIA
Last Name:ATAIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N MARKET ST # 300
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95113-1211
Mailing Address - Country:US
Mailing Address - Phone:408-931-0544
Mailing Address - Fax:
Practice Address - Street 1:2 N MARKET ST # 300
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-1211
Practice Address - Country:US
Practice Address - Phone:408-931-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator