Basic Information
Provider Information | |||||||||
NPI: | 1497103659 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DE GREGORIO | ||||||||
FirstName: | LUCIA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DE GREGORIO MUNIZ | ||||||||
OtherFirstName: | LUCIA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 5339 HARRY HINES BLVD | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 753907208 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2146451947 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2160 S 1ST AVE | ||||||||
Address2: |   | ||||||||
City: | MAYWOOD | ||||||||
State: | IL | ||||||||
PostalCode: | 601533328 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7082169000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/28/2016 | ||||||||
LastUpdateDate: | 10/03/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/03/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | S9674 | TX | N |   | Allopathic & Osteopathic Physicians | Transplant Surgery |   | 208600000X | 46610 | TX | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 204F00000X | 036161827 | IL | Y |   | Allopathic & Osteopathic Physicians | Transplant Surgery |   |
No ID Information.