Provider Demographics
NPI:1174599526
Name:CLERSAINT, LUCITA MARTHE (DPM)
Entity type:Individual
Prefix:DR
First Name:LUCITA
Middle Name:MARTHE
Last Name:CLERSAINT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277955
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-7955
Mailing Address - Country:US
Mailing Address - Phone:305-944-1610
Mailing Address - Fax:305-944-1670
Practice Address - Street 1:58 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33162-3401
Practice Address - Country:US
Practice Address - Phone:305-944-1610
Practice Address - Fax:305-944-1670
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-26
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2776213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390479200Medicaid
U75524Medicare UPIN
65617YMedicare PIN