Provider Demographics
NPI:1376319657
Name:DE JESUS, LUTGARDA SANCHEZ
Entity Type:Individual
Prefix:
First Name:LUTGARDA
Middle Name:SANCHEZ
Last Name:DE JESUS
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 1:3662 BENSON AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-3552
Mailing Address - Country:US
Mailing Address - Phone:727-902-7943
Mailing Address - Fax:
Practice Address - Street 1:3662 BENSON AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-3552
Practice Address - Country:US
Practice Address - Phone:727-902-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services