Provider Demographics
NPI:1033473079
Name:LANTIGUA, AMARILIS
Entity Type:Individual
Prefix:MS
First Name:AMARILIS
Middle Name:
Last Name:LANTIGUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SEWARD DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7908
Mailing Address - Country:US
Mailing Address - Phone:631-742-5996
Mailing Address - Fax:
Practice Address - Street 1:34 SEWARD DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7908
Practice Address - Country:US
Practice Address - Phone:631-742-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY763607971174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY763607971OtherSPECIAL EDUCATION TEACHER