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1770619967 NPI number — LETICIA PERONDI LUZ M.D.

NPI Number: 1770619967
Health Care Provider/Practitioner: LETICIA PERONDI LUZ M.D.

Information about “1770619967” NPI (LETICIA PERONDI LUZ M.D.) exists in 1770619967 in HTML format HTML  |  1770619967 in plain Text format TXT  |  1770619967 in PDF (Portable Document Format) PDF  |  1770619967 in an XML format XML  formats.

NPI Number : 1770619967 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770619967",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PERONDI LUZ",
    "FirstName": "LETICIA",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LUZ",
    "OtherFirstName": "LETICIA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "8170 33RD AVE S # MS 21110Q",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BLOOMINGTON",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55425-4516",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6500 EXCELSIOR BLVD",
    "SecondLinePracticeLocationAddress": "SUITE4-820",
    "PracticeLocationAddressCityName": "ST LOUIS PARK",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55426-4702",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "952-993-2750",
    "PracticeLocationAddressFaxNumber": "952-993-0300",
    "EnumerationDate": "02/24/2007",
    "LastUpdateDate": "03/10/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RG0100X",
        "TaxonomyName": "Gastroenterology Physician",
        "LicenseNumber": "107536",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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