Healthcare Provider Details

I. General information

NPI: 1265222871
Provider Name (Legal Business Name): LIA PAULINO-OVALLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 COLLEGE PKWY STE 107
FORT MYERS FL
33919-4111
US

IV. Provider business mailing address

315 SW PINE ISLAND RD APT 330
CAPE CORAL FL
33991-2174
US

V. Phone/Fax

Practice location:
  • Phone: 239-360-7967
  • Fax:
Mailing address:
  • Phone: 786-620-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberP451-525-05-622-0
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: