Provider Demographics
NPI:1972891935
Name:LUCIA MEDICAL CENTER INC
Entity Type:Organization
Organization Name:LUCIA MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:DUENAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMT
Authorized Official - Phone:786-315-8198
Mailing Address - Street 1:1201 S FEDERAL HWY STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-5644
Mailing Address - Country:US
Mailing Address - Phone:786-315-8198
Mailing Address - Fax:
Practice Address - Street 1:1201 S FEDERAL HWY STE A
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-5644
Practice Address - Country:US
Practice Address - Phone:786-315-8198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center