Provider Demographics
NPI:1811375678
Name:L. AMERICAN CORP
Entity Type:Organization
Organization Name:L. AMERICAN CORP
Other - Org Name:RANCHO LUNA RESTAURANT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSQUEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-642-9123
Mailing Address - Street 1:45 NW 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5213
Mailing Address - Country:US
Mailing Address - Phone:305-642-9123
Mailing Address - Fax:305-642-9951
Practice Address - Street 1:45 NW 22ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5213
Practice Address - Country:US
Practice Address - Phone:305-642-9123
Practice Address - Fax:305-642-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSEA2302820332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals