Provider Demographics
NPI:1326333295
Name:MURCIA LEMUS, LUIS MARIO (SA-C)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:MARIO
Last Name:MURCIA LEMUS
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 GORMLEY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3007
Mailing Address - Country:US
Mailing Address - Phone:305-431-3919
Mailing Address - Fax:
Practice Address - Street 1:706 GORMLEY DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3007
Practice Address - Country:US
Practice Address - Phone:305-431-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL07-181363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical