1659019479 NPI number — LUCIANA LERENDEGUI MD

Table of content: LUCIANA LERENDEGUI MD (NPI 1659019479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659019479 NPI number — LUCIANA LERENDEGUI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LERENDEGUI
Provider First Name:
LUCIANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659019479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/20/2023
NPI Reactivation Date:
02/22/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 SW 60
Provider Second Line Business Mailing Address:
PEDIATRIC UROLOGY, COURT #104
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-669-6448
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 NW 12 AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-669-6448
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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