Provider Demographics
NPI:1104122290
Name:LEO, LUCIANA (LAC DOM)
Entity type:Individual
Prefix:
First Name:LUCIANA
Middle Name:
Last Name:LEO
Suffix:
Gender:F
Credentials:LAC DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3673 SW 13TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1013
Mailing Address - Country:US
Mailing Address - Phone:786-306-4967
Mailing Address - Fax:305-461-8230
Practice Address - Street 1:351 MINORCA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4317
Practice Address - Country:US
Practice Address - Phone:305-461-8229
Practice Address - Fax:305-461-8230
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2897171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist