1194969873 NPI number — DR. TERESA LORRAINE AUCK LUCIA M.D.

Table of content: AHMAD ASHFAQ M.D. (NPI 1871729517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194969873 NPI number — DR. TERESA LORRAINE AUCK LUCIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCIA
Provider First Name:
TERESA
Provider Middle Name:
LORRAINE AUCK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TALENS
Provider Other First Name:
TERESA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194969873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1004 SOUTH ROCK STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-279-0348
Provider Business Mailing Address Fax Number:
512-371-8788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5656 WEST BEE CAVES ROAD
Provider Second Line Business Practice Location Address:
SUITE M-302
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-5236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-697-3502
Provider Business Practice Location Address Fax Number:
512-697-3501
Provider Enumeration Date:
04/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  P6452 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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