Provider Demographics
NPI:1417374489
Name:NOEL, LOUCASADA
Entity Type:Individual
Prefix:
First Name:LOUCASADA
Middle Name:
Last Name:NOEL
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 1:6486 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3884
Mailing Address - Country:US
Mailing Address - Phone:786-546-3575
Mailing Address - Fax:954-322-4199
Practice Address - Street 1:2003 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6317
Practice Address - Country:US
Practice Address - Phone:786-546-3575
Practice Address - Fax:954-322-4199
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11963879310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility