Healthcare Provider Details

I. General information

NPI: 1659019479
Provider Name (Legal Business Name): LUCIANA LERENDEGUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date: 02/20/2023
Reactivation Date: 02/22/2023

III. Provider practice location address

3200 SW 60TH CT STE 104
MIAMI FL
33155-4069
US

IV. Provider business mailing address

3200 SW 60 PEDIATRIC UROLOGY, COURT #104
MIAMI FL
33155
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-6448
  • Fax:
Mailing address:
  • Phone: 305-669-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberME170911
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: