Provider Demographics
NPI:1174910509
Name:DEJESUS, LUZ
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:DEJESUS
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 1:26600 SW 146TH CT
Mailing Address - Street 2:505
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6507
Mailing Address - Country:US
Mailing Address - Phone:305-969-9448
Mailing Address - Fax:305-969-9748
Practice Address - Street 1:10680 SW 186TH ST
Practice Address - Street 2:36
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6720
Practice Address - Country:US
Practice Address - Phone:305-969-9448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ16388101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral