Provider Demographics
NPI:1154458883
Name:USATEGUI, LYDIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:M
Last Name:USATEGUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 S.W. 74 STREET, SUITE 214
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-595-5959
Mailing Address - Fax:305-279-6684
Practice Address - Street 1:5901 S.W. 74 STREET, SUITE 214
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-595-5959
Practice Address - Fax:305-279-6684
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 406842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
34036Medicare PIN
D21529Medicare UPIN