Provider Demographics
NPI:1255050886
Name:MONTERO SALAZAR, LUCYLINA (LMT)
Entity type:Individual
Prefix:
First Name:LUCYLINA
Middle Name:
Last Name:MONTERO SALAZAR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 CENTERGATE DR APT 101
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7272
Mailing Address - Country:US
Mailing Address - Phone:786-631-0684
Mailing Address - Fax:
Practice Address - Street 1:2589 CENTERGATE DR APT 101
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7272
Practice Address - Country:US
Practice Address - Phone:786-631-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA100619225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty