Provider Demographics
NPI:1194758714
Name:SICAT, LUZVIMINDA F (MD)
Entity type:Individual
Prefix:MRS
First Name:LUZVIMINDA
Middle Name:F
Last Name:SICAT
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 1:10400 VILLA RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-7418
Mailing Address - Country:US
Mailing Address - Phone:702-349-5714
Mailing Address - Fax:
Practice Address - Street 1:10400 VILLA RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-7418
Practice Address - Country:US
Practice Address - Phone:702-349-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33337174400000X
MO2009002320174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist