Provider Demographics
NPI:1962659862
Name:LUSCO, SALVADOR A (M D)
Entity Type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:A
Last Name:LUSCO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 BIRDIE DR
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2404
Mailing Address - Country:US
Mailing Address - Phone:225-654-6636
Mailing Address - Fax:
Practice Address - Street 1:1414 BIRDIE DR
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2404
Practice Address - Country:US
Practice Address - Phone:225-654-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009435174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist