Individual
LAQUAVIAN ELIACIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1738 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5467
(772) 200-0870
Mailing address
1738 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5467
(772) 200-0870
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
09/22/2020
Last updated
09/22/2020
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