Provider Demographics
NPI:1538845862
Name:VERGARA FERRAZ DE SOUZA, LUCIANA (MD)
Entity type:Individual
Prefix:
First Name:LUCIANA
Middle Name:
Last Name:VERGARA FERRAZ DE SOUZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCONN HEALTH - OUTPATIENT PAVILLION
Mailing Address - Street 2:263 FARMINGTON AVENUE
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-8021
Mailing Address - Country:US
Mailing Address - Phone:860-679-4477
Mailing Address - Fax:860-679-1025
Practice Address - Street 1:UCONN HEALTH - OUTPATIENT PAVILLION
Practice Address - Street 2:263 FARMINGTON AVENUE
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-8021
Practice Address - Country:US
Practice Address - Phone:860-679-4477
Practice Address - Fax:860-679-1025
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program