Provider Demographics
NPI:1386974848
Name:ASIA, LETICIA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:ASIA
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 1:19 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1413
Mailing Address - Country:US
Mailing Address - Phone:617-650-5901
Mailing Address - Fax:508-502-8342
Practice Address - Street 1:19 MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:MA
Practice Address - Zip Code:01612-1413
Practice Address - Country:US
Practice Address - Phone:617-650-5901
Practice Address - Fax:508-502-8342
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA260846373H00000X
MA793716163WH1000X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA331216699OtherSTATE