Provider Demographics
NPI:1366947905
Name:LUCE, MARIE SIOBHAN
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:SIOBHAN
Last Name:LUCE
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:FMG SURGERY SUITE 2100 11370 ANDERSON STREET
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0001
Mailing Address - Country:US
Mailing Address - Phone:775-544-1546
Mailing Address - Fax:
Practice Address - Street 1:FMG SURGERY SUITE 2100 11370 ANDERSON STREET
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1742
Practice Address - Country:US
Practice Address - Phone:775-544-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1640952086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery