1083164644 NPI number — MS. LUCIANA GENEVIEVE MAYO LBS

Table of content: MS. LUCIANA GENEVIEVE MAYO LBS (NPI 1083164644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083164644 NPI number — MS. LUCIANA GENEVIEVE MAYO LBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAYO
Provider First Name:
LUCIANA
Provider Middle Name:
GENEVIEVE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LBS
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1083164644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 ENGLEWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER DARBY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19082-1517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-319-6162
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 NESHAMINY INTERPLEX DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
TREVOSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19053-6944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-322-8860
Provider Business Practice Location Address Fax Number:
215-332-8867
Provider Enumeration Date:
10/07/2016

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: 106E00000X , with the licence number:  BH003123 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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