Provider Demographics
NPI:1548350721
Name:PUCCIO HERNANDEZ, LUCIANO (MD)
Entity type:Individual
Prefix:DR
First Name:LUCIANO
Middle Name:
Last Name:PUCCIO HERNANDEZ
Suffix:
Gender:M
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:PO BOX 1756
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1756
Mailing Address - Country:US
Mailing Address - Phone:787-349-5100
Mailing Address - Fax:
Practice Address - Street 1:AVE. 65 INFANTERY
Practice Address - Street 2:CARR. #3 KM 8.3
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7335208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC82280Medicare UPIN