Provider Demographics
NPI:1043075153
Name:LINO LATERZA, LIA (LAC)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:
Last Name:LINO LATERZA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53402-2780
Mailing Address - Country:US
Mailing Address - Phone:414-388-9736
Mailing Address - Fax:
Practice Address - Street 1:17040 W GREENFIELD AVE STE 6
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6844
Practice Address - Country:US
Practice Address - Phone:262-439-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2046171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist