Healthcare Provider Details

I. General information

NPI: 1639909054
Provider Name (Legal Business Name): LILIAN HERRERA DUARTE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 W 64TH ST
HIALEAH FL
33012-6636
US

IV. Provider business mailing address

431 W 64TH ST
HIALEAH FL
33012-6636
US

V. Phone/Fax

Practice location:
  • Phone: 786-899-1167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-334914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: