Provider Demographics
NPI:1033395645
Name:LUCITA M CLERSAINT DPM P A
Entity Type:Organization
Organization Name:LUCITA M CLERSAINT DPM P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLERSAINT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-944-1610
Mailing Address - Street 1:PO BOX 277955
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-7955
Mailing Address - Country:US
Mailing Address - Phone:305-944-1610
Mailing Address - Fax:305-944-1670
Practice Address - Street 1:58 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33162-3401
Practice Address - Country:US
Practice Address - Phone:305-944-1610
Practice Address - Fax:305-944-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2776213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390479200Medicaid
FLU75524Medicare UPIN
FL390479200Medicaid
FLAJ367Medicare PIN