Provider Demographics
NPI:1689434268
Name:LOACES LEMUS, IREIDY
Entity Type:Individual
Prefix:
First Name:IREIDY
Middle Name:
Last Name:LOACES LEMUS
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 1:2993 W 80TH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7244
Mailing Address - Country:US
Mailing Address - Phone:786-715-0579
Mailing Address - Fax:
Practice Address - Street 1:2993 W 80TH ST APT 9
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-7244
Practice Address - Country:US
Practice Address - Phone:786-715-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-324781106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician