Provider Demographics
NPI:1659602969
Name:LUALDI, LUCIANA (PA-C)
Entity Type:Individual
Prefix:
First Name:LUCIANA
Middle Name:
Last Name:LUALDI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 CRANDON BLVD APT 305
Mailing Address - Street 2:
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-2508
Mailing Address - Country:US
Mailing Address - Phone:305-608-2750
Mailing Address - Fax:
Practice Address - Street 1:743 CRANDON BLVD APT 305
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-2508
Practice Address - Country:US
Practice Address - Phone:305-608-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109730363A00000X
FL09-178246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant