Provider Demographics
NPI:1881052801
Name:DE LUCIO, ALYCIA (RN)
Entity type:Individual
Prefix:
First Name:ALYCIA
Middle Name:
Last Name:DE LUCIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 ARGONAUT
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4116
Mailing Address - Country:US
Mailing Address - Phone:949-916-8868
Mailing Address - Fax:
Practice Address - Street 1:92 ARGONAUT
Practice Address - Street 2:SUITE 205
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4116
Practice Address - Country:US
Practice Address - Phone:949-916-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA591974163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0150193OtherMEDI-CAL