Provider Demographics
NPI:1760474894
Name:TUFFANELLI, LUCIA R (MD)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:R
Last Name:TUFFANELLI
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 1:450 SUTTER ST
Mailing Address - Street 2:STE 1306
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-781-4083
Mailing Address - Fax:415-781-4104
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:STE 1306
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-781-4083
Practice Address - Fax:415-781-4104
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53460207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06917Medicare UPIN
00G534600Medicare ID - Type Unspecified