Provider Demographics
NPI:1437757572
Name:GIL, LUCINIO
Entity Type:Individual
Prefix:
First Name:LUCINIO
Middle Name:
Last Name:GIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045 NW 37TH ST APT 103W
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7053
Mailing Address - Country:US
Mailing Address - Phone:786-304-0075
Mailing Address - Fax:
Practice Address - Street 1:6045 NW 37TH ST APT 103W
Practice Address - Street 2:
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-7053
Practice Address - Country:US
Practice Address - Phone:786-304-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty