Healthcare Provider Details

I. General information

NPI: 1376268359
Provider Name (Legal Business Name): LUCILLE CATHERINE OPAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 CARROLL ST APT 37
BROOKLYN NY
11213-4540
US

IV. Provider business mailing address

1497 CARROLL ST APT 37
BROOKLYN NY
11213-4540
US

V. Phone/Fax

Practice location:
  • Phone: 561-676-7855
  • Fax:
Mailing address:
  • Phone: 561-676-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032619
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: