Provider Demographics
NPI:1700874690
Name:SOUNESS, LUZVIMINDA (PA)
Entity Type:Individual
Prefix:
First Name:LUZVIMINDA
Middle Name:
Last Name:SOUNESS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-921-9212
Practice Address - Street 1:125 METRO CENTER BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1785
Practice Address - Country:US
Practice Address - Phone:401-432-2520
Practice Address - Fax:401-921-9212
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA00189363A00000X
RIPA00189363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
302759OtherBLUESHIELD
970022493OtherRAILROAD MEDICARE
408927OtherBLUECHIP
007009177OtherHOSPITALPIN
7009176OtherRIMEDICAL ASSISTANCE