Provider Demographics
NPI:1225690563
Name:LUCIEN, ANNIE SAIKA
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:SAIKA
Last Name:LUCIEN
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 1:2341 NW 38TH TER
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-2650
Mailing Address - Country:US
Mailing Address - Phone:954-635-8981
Mailing Address - Fax:
Practice Address - Street 1:2341 NW 38TH TER
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-2650
Practice Address - Country:US
Practice Address - Phone:954-635-8981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3848302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLANNIE20Medicaid