MEDICARE: LUTGARDA SANCHEZ DE JESUS

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1376319657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUTGARDA SANCHEZ DE JESUS

Provider Business Mailing Address
First Line	:	3662 BENSON AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-3552
Country	:	US
Telephone Number	:	727-902-7943
Fax Number	:

Provider Business Practice Location Address
First Line	:	3662 BENSON AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-3552
Country	:	US
Telephone Number	:	727-902-7943
Fax Number	:

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

Provider Enumeration Date	:	11/28/2023
Last Update Date	:	11/28/2023

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