Basic Information
| Provider Information | |||||||||
| NPI: | 1881978351 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LUCILA MEDICAL PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 780 ALLWOOD RD | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070121923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732496202 | ||||||||
| FaxNumber: | 9732496203 | ||||||||
| Practice Location | |||||||||
| Address1: | 780 ALLWOOD RD | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070121923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732496202 | ||||||||
| FaxNumber: | 9732496203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2011 | ||||||||
| LastUpdateDate: | 10/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | LUCILA | ||||||||
| AuthorizedOfficialFirstName: | RAFAEL R | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9732496202 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.