Provider Demographics
NPI:1962683219
Name:LUSITANA HEALTHCARE, LLC.
Entity Type:Organization
Organization Name:LUSITANA HEALTHCARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:PALHETE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-334-2000
Mailing Address - Street 1:2660 MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5369
Mailing Address - Country:US
Mailing Address - Phone:203-334-2000
Mailing Address - Fax:
Practice Address - Street 1:2660 MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5369
Practice Address - Country:US
Practice Address - Phone:203-334-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044625261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care