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General NPI Number Information
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NPI Number | 1770619967
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Entity Type | Individual
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Provider Name | LETICIA PERONDI LUZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/24/2007
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 6500 EXCELSIOR BLVD SUITE4-820
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-4702
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Country | US
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Telephone | 952-993-2750
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Fax | 952-993-0300
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE S # MS 21110Q
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 107536
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License Number State | MN
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