Healthcare Provider Details

I. General information

NPI: 1629746730
Provider Name (Legal Business Name): LUCIANA LAVILAIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date: 05/28/2022
Reactivation Date: 10/02/2025

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

3300 S UNIVERSITY DR
FT LAUDERDALE FL
33328-2004
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9120739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: