Healthcare Provider Details

I. General information

NPI: 1871802371
Provider Name (Legal Business Name): LELUMIERE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 SUN N LAKE BLVD SUITE 105
SEBRING FL
33872-2171
US

IV. Provider business mailing address

4325 SUN N LAKE BLVD SUITE 105
SEBRING FL
33872-2171
US

V. Phone/Fax

Practice location:
  • Phone: 836-471-0050
  • Fax: 863-382-4899
Mailing address:
  • Phone: 836-471-0050
  • Fax: 863-382-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMM17142
License Number StateFL

VIII. Authorized Official

Name: GABRIEL A PULIDO
Title or Position: MEDICAL DIRECTOR/CHAIRMAN
Credential: M.D.
Phone: 863-471-0050