Provider Demographics
NPI:1114366085
Name:MONEXE, LUCKNER
Entity Type:Individual
Prefix:
First Name:LUCKNER
Middle Name:
Last Name:MONEXE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20458 NW 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2478
Mailing Address - Country:US
Mailing Address - Phone:305-812-4015
Mailing Address - Fax:
Practice Address - Street 1:14750 SW 26TH ST
Practice Address - Street 2:209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5933
Practice Address - Country:US
Practice Address - Phone:305-364-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist