Provider Demographics
NPI:1104893965
Name:JOSEPHS, LUCILA S (MD)
Entity type:Individual
Prefix:
First Name:LUCILA
Middle Name:S
Last Name:JOSEPHS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MIRACLE MILE, SUITE 300
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-447-1246
Mailing Address - Fax:305-447-0249
Practice Address - Street 1:401 MIRACLE MILE, SUITE 300
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-447-1246
Practice Address - Fax:305-447-0249
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000295OtherAV-MED
FL95632OtherBCBS