Provider Demographics
NPI:1871802371
Name:LELUMIERE,INC
Entity type:Organization
Organization Name:LELUMIERE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PULIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-471-0050
Mailing Address - Street 1:4325 SUN N LAKE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2171
Mailing Address - Country:US
Mailing Address - Phone:836-471-0050
Mailing Address - Fax:863-382-4899
Practice Address - Street 1:4325 SUN N LAKE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2171
Practice Address - Country:US
Practice Address - Phone:836-471-0050
Practice Address - Fax:863-382-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM17142173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM17142OtherMASSAGE HERAPIST