Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 16388 | ZZ |
NPI | 1174910509 |
---|---|
Provider Name | Luz Dejesus |
First Address | Homestead, FL 33032-6507 |
Second Address | Cutler Bay, FL 33157-6720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2015 |
Last Update Date | 23/04/2015 |