Provider Demographics
NPI:1588267967
Name:LUCIN-MARTIN, SA'DE C
Entity type:Individual
Prefix:
First Name:SA'DE
Middle Name:C
Last Name:LUCIN-MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BEL PORT DR UNIT 151
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-0175
Mailing Address - Country:US
Mailing Address - Phone:916-254-9885
Mailing Address - Fax:
Practice Address - Street 1:2881 S VALLEY VIEW BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0170
Practice Address - Country:US
Practice Address - Phone:702-852-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No374700000XNursing Service Related ProvidersTechnician