Provider Demographics
NPI:1043697790
Name:ANASAGASTI, LUZ
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:ANASAGASTI
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 1:20443 NW 11TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FLORIDA
Mailing Address - Zip Code:33169
Mailing Address - Country:UM
Mailing Address - Phone:646-755-5657
Mailing Address - Fax:
Practice Address - Street 1:20443 NW 11TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-2342
Practice Address - Country:US
Practice Address - Phone:646-755-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01292000Medicaid