Provider Demographics
NPI:1063976348
Name:CONCEPCION SEDA, LUI MICHELLE
Entity type:Individual
Prefix:
First Name:LUI
Middle Name:MICHELLE
Last Name:CONCEPCION SEDA
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 1:1212 CALLE LUCHETTI APT 701
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1872
Mailing Address - Country:US
Mailing Address - Phone:787-209-9063
Mailing Address - Fax:
Practice Address - Street 1:1212 CALLE LUCHETTI APT 701
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1872
Practice Address - Country:US
Practice Address - Phone:787-209-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program