Healthcare Provider Details

I. General information

NPI: 1700373479
Provider Name (Legal Business Name): ADYSLEIDIS LLUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 N KROME AVE STE 206
HOMESTEAD FL
33030-6047
US

IV. Provider business mailing address

9601 SW 36TH ST
MIAMI FL
33165-4047
US

V. Phone/Fax

Practice location:
  • Phone: 786-410-8922
  • Fax:
Mailing address:
  • Phone: 305-987-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: