Provider Demographics
NPI:1902329964
Name:LUZINCOURT, MIRASSANIA (CRDH)
Entity Type:Individual
Prefix:
First Name:MIRASSANIA
Middle Name:
Last Name:LUZINCOURT
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:MRS
Other - First Name:MIRASSANIA
Other - Middle Name:
Other - Last Name:ST VICTOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRDH
Mailing Address - Street 1:865 NW 80TH TER
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-4051
Mailing Address - Country:US
Mailing Address - Phone:954-851-5367
Mailing Address - Fax:
Practice Address - Street 1:3510 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3840
Practice Address - Country:US
Practice Address - Phone:305-576-1234
Practice Address - Fax:305-571-1887
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH24788124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist