Provider Demographics
NPI:1831743756
Name:DE LUCCHI, ANDREW ERIC JR (BSW)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ERIC
Last Name:DE LUCCHI
Suffix:JR
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 PYRAMID WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-2160
Mailing Address - Country:US
Mailing Address - Phone:775-322-4650
Mailing Address - Fax:775-322-3137
Practice Address - Street 1:2261 PYRAMID WAY STE 5
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2160
Practice Address - Country:US
Practice Address - Phone:775-322-4650
Practice Address - Fax:775-322-3137
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner