Provider Demographics
NPI:1821885203
Name:DE MELLO, LUCIMARA PUGLIELLI
Entity type:Individual
Prefix:
First Name:LUCIMARA
Middle Name:PUGLIELLI
Last Name:DE MELLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 NE 123RD ST APT PH16
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6033
Mailing Address - Country:US
Mailing Address - Phone:786-898-2930
Mailing Address - Fax:
Practice Address - Street 1:1470 NE 123RD ST APT PH16
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-6033
Practice Address - Country:US
Practice Address - Phone:786-898-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1066388225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist