Provider Demographics
NPI:1619642238
Name:LEON SANTIAGO, LUCERO PILAR
Entity Type:Individual
Prefix:
First Name:LUCERO
Middle Name:PILAR
Last Name:LEON SANTIAGO
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 1:1001 BRICKELL BAY DR STE 2700
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-4940
Mailing Address - Country:US
Mailing Address - Phone:305-389-2292
Mailing Address - Fax:305-397-0277
Practice Address - Street 1:1001 BRICKELL BAY DR STE 2700
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-4940
Practice Address - Country:US
Practice Address - Phone:305-389-2292
Practice Address - Fax:305-397-0277
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW41541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical