Healthcare Provider Details

I. General information

NPI: 1326989781
Provider Name (Legal Business Name): LILIANNA CHAVEZ MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 SE 14TH ST
CAPE CORAL FL
33990-2134
US

IV. Provider business mailing address

602 SE 14TH ST
CAPE CORAL FL
33990-2134
US

V. Phone/Fax

Practice location:
  • Phone: 786-302-3436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-524619
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: