Healthcare Provider Details

I. General information

NPI: 1063114205
Provider Name (Legal Business Name): ANDREA REFOJOS LIANO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 W STATE ROAD 436 STE 1040
ALTAMONTE SPRINGS FL
32714-2917
US

IV. Provider business mailing address

7718 ANSELMO LN
WINDERMERE FL
34786-6732
US

V. Phone/Fax

Practice location:
  • Phone: 407-403-5567
  • Fax:
Mailing address:
  • Phone: 787-479-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH13997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: