Provider Demographics
NPI:1790015485
Name:THE DOCTORS LUCE PEDIATRICS, LLC
Entity type:Organization
Organization Name:THE DOCTORS LUCE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PRESIDENT/PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARI
Authorized Official - Middle Name:SUTO
Authorized Official - Last Name:LUCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-713-5330
Mailing Address - Street 1:20229 SW TREMONT WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8594
Mailing Address - Country:US
Mailing Address - Phone:503-718-7802
Mailing Address - Fax:503-718-7802
Practice Address - Street 1:16280 NW BETHANY CT
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4885
Practice Address - Country:US
Practice Address - Phone:503-713-5330
Practice Address - Fax:503-713-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-03
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care