Provider Demographics
NPI:1881025732
Name:LORISTON, LEONAISE
Entity type:Individual
Prefix:
First Name:LEONAISE
Middle Name:
Last Name:LORISTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 SW 147TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1503
Mailing Address - Country:US
Mailing Address - Phone:305-303-1554
Mailing Address - Fax:
Practice Address - Street 1:8614 SW 147TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1503
Practice Address - Country:US
Practice Address - Phone:305-303-1554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator