Provider Demographics
NPI:1811669393
Name:SAINT-BUZON, LILA KAMALA (LMT, PTC)
Entity type:Individual
Prefix:
First Name:LILA
Middle Name:KAMALA
Last Name:SAINT-BUZON
Suffix:
Gender:F
Credentials:LMT, PTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 BUCK RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13750-8314
Mailing Address - Country:US
Mailing Address - Phone:310-463-7225
Mailing Address - Fax:
Practice Address - Street 1:615 BUCK RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:NY
Practice Address - Zip Code:13750-8314
Practice Address - Country:US
Practice Address - Phone:310-463-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032631225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty