Provider Demographics
NPI:1083377816
Name:LOMINCHAR, ELISA M
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:M
Last Name:LOMINCHAR
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 1:6980 W 2ND WAY
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5320
Mailing Address - Country:US
Mailing Address - Phone:786-663-6499
Mailing Address - Fax:
Practice Address - Street 1:6980 W 2ND WAY
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5320
Practice Address - Country:US
Practice Address - Phone:786-663-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty