Provider Demographics
NPI:1386988095
Name:LUCIO, CHRISTOPHER MICHAEL
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:LUCIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 DUNBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-3630
Mailing Address - Country:US
Mailing Address - Phone:407-886-2187
Mailing Address - Fax:
Practice Address - Street 1:1121 DUNBRIDGE ST
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-3630
Practice Address - Country:US
Practice Address - Phone:407-886-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL200113820660251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable