Provider Demographics
NPI:1598217044
Name:MONTENEGRO, LUCENA
Entity Type:Individual
Prefix:
First Name:LUCENA
Middle Name:
Last Name:MONTENEGRO
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 1:4980 W SAHARA AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3435
Mailing Address - Country:US
Mailing Address - Phone:702-820-5070
Mailing Address - Fax:702-945-0314
Practice Address - Street 1:4980 W SAHARA AVE STE 260
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3435
Practice Address - Country:US
Practice Address - Phone:702-820-5070
Practice Address - Fax:702-945-0314
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005528225100000X
NV4711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist