MEDICARE: CAROLINA LUQUE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154853554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA LUQUE

Provider Business Mailing Address
First Line	:	6002 GRAND PALM DR
Second Line	:	APT 417
City	:	TAMPA
State	:	FL
Zip	:	33647-2663
Country	:	US
Telephone Number	:	561-398-8303
Fax Number	:

Provider Business Practice Location Address
First Line	:	6002 GRAND PALM DR
Second Line	:	APT 417
City	:	TAMPA
State	:	FL
Zip	:	33647-2663
Country	:	US
Telephone Number	:	561-398-8303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/03/2017

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Directions to “ CAROLINA LUQUE ” Practice Location

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