Healthcare Provider Details

I. General information

NPI: 1811287253
Provider Name (Legal Business Name): LUCSEN SAINTIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5977 NW BAYNARD DR
PORT SAINT LUCIE FL
34986-3604
US

IV. Provider business mailing address

5977 NW BAYNARD DR
PORT SAINT LUCIE FL
34986-3604
US

V. Phone/Fax

Practice location:
  • Phone: 772-224-1824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: