Provider Demographics
NPI:1922076967
Name:LUCCA PELAEZ, FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:LUCCA PELAEZ
Suffix:
Gender:M
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:AVE. WINSTON CHURCHILL PMB 619138
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7661
Mailing Address - Country:US
Mailing Address - Phone:787-763-0216
Mailing Address - Fax:787-765-7864
Practice Address - Street 1:AVE. WINSTON CHURCHILL PMB 619138
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7661
Practice Address - Country:US
Practice Address - Phone:787-763-0216
Practice Address - Fax:787-765-7864
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11719208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG40965Medicare UPIN