Lusco, Mattie G

Lusco, Mattie G is an sole proprietor health care provider with primary practice located at 623 Beechwood St , Jacksonville FL 32206-6236. She recently has only one registered license in Agencies / Case Management, which is considered as her primary health care specialty. Lusco, Mattie G can be contacted via phone (904) 358-1211.

Contact Information

Primary practice address
623 Beechwood St Jacksonville FL 32206-6236
Phone: (904) 358-1211
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Agencies / Case Management 251B00000X

Profile Details

NPI number 1235412206
LBN Legal business name Lusco, Mattie G
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 26th, 2011
Last updated Dec 16th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235412206 NPPES
Florida MEDICAID 675446500

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