Provider Demographics
NPI:1992969075
Name:CHUECA VILLA, LUCERO C (MD, FACP)
Entity type:Individual
Prefix:
First Name:LUCERO
Middle Name:C
Last Name:CHUECA VILLA
Suffix:
Gender:F
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W INDIANTOWN RD STE 203B
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3539
Mailing Address - Country:US
Mailing Address - Phone:313-515-0710
Mailing Address - Fax:888-494-2192
Practice Address - Street 1:125 W INDIANTOWN RD STE 203B
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3539
Practice Address - Country:US
Practice Address - Phone:313-515-0710
Practice Address - Fax:888-494-2192
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092988207R00000X
FLME125686207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine