Basic Information
| Provider Information | |||||||||
| NPI: | 1780988709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUCY | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | SEAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5601 DOMINGO RD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871081610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052685295 | ||||||||
| FaxNumber: | 5052689967 | ||||||||
| Practice Location | |||||||||
| Address1: | 5601 DOMINGO RD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871081610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052685295 | ||||||||
| FaxNumber: | 5052689967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2011 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | 00988780 | TX | Y | Other Service Providers | Community Health Worker |
No ID Information.