Healthcare Provider Details

I. General information

NPI: 1033395645
Provider Name (Legal Business Name): LUCITA M CLERSAINT DPM P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 NE 167TH ST
MIAMI FL
33162-3401
US

IV. Provider business mailing address

PO BOX 277955
MIRAMAR FL
33027-7955
US

V. Phone/Fax

Practice location:
  • Phone: 305-944-1610
  • Fax: 305-944-1670
Mailing address:
  • Phone: 305-944-1610
  • Fax: 305-944-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2776
License Number StateFL

VIII. Authorized Official

Name: DR. LUCITA M CLERSAINT
Title or Position: PRESIDENT
Credential: DPM
Phone: 305-944-1610