Healthcare Provider Details

I. General information

NPI: 1043907629
Provider Name (Legal Business Name): BARBARA A LALUZ CRPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 06/17/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CLAY AVE APT 4M
BRONX NY
10456-1777
US

IV. Provider business mailing address

1450 CLAY AVE APT 4M
BRONX NY
10456-1777
US

V. Phone/Fax

Practice location:
  • Phone: 917-553-6646
  • Fax:
Mailing address:
  • Phone: 917-553-6646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberBQIHZ9JEXM
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number5638
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: