Provider Demographics
NPI:1376183194
Name:LACAYO, RUTH CARMEN (L,AP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:CARMEN
Last Name:LACAYO
Suffix:
Gender:F
Credentials:L,AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15375 SW 105TH LN APT 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2700
Mailing Address - Country:US
Mailing Address - Phone:786-626-9604
Mailing Address - Fax:
Practice Address - Street 1:7520 SW 57TH AVE STE K
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5330
Practice Address - Country:US
Practice Address - Phone:786-626-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist