Provider Demographics
NPI:1174895304
Name:LUSTGARTEN, PRACHI
Entity type:Individual
Prefix:
First Name:PRACHI
Middle Name:
Last Name:LUSTGARTEN
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 1:1801 SE COCONUT STREET
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455
Mailing Address - Country:US
Mailing Address - Phone:561-312-3940
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:1801 SE COCONUT STREET
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455
Practice Address - Country:US
Practice Address - Phone:561-312-3940
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information