Provider Demographics
NPI:1124824800
Name:LUCAS, LEILA
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:LUCAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 HOLLYWOOD BLVD APT 1C
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6534
Mailing Address - Country:US
Mailing Address - Phone:954-668-1252
Mailing Address - Fax:
Practice Address - Street 1:4800 HOLLYWOOD BLVD APT 1C
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6534
Practice Address - Country:US
Practice Address - Phone:954-668-1252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter