MEDICARE: LILLIANA RUIZ FERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1205354149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIANA RUIZ FERNANDEZ

Provider Business Mailing Address
First Line	:	300 NW 42ND AVE APT 205
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5656
Country	:	US
Telephone Number	:	786-458-3218
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 NW 42ND AVE APT 205
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5656
Country	:	US
Telephone Number	:	786-458-3218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2017
Last Update Date	:	07/21/2022

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