Provider Demographics
NPI:1790430064
Name:BOETTNER, LUCIA BELEN (MD)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:BELEN
Last Name:BOETTNER
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 1:51 TARA DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-2622
Mailing Address - Country:US
Mailing Address - Phone:617-314-1353
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST STE 234AND7B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-4883
Practice Address - Fax:718-579-6299
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program