Healthcare Provider Details

I. General information

NPI: 1912728247
Provider Name (Legal Business Name): LIANET REY MOREJON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 W 36TH ST
HIALEAH FL
33012-5137
US

IV. Provider business mailing address

781 W 36TH ST
HIALEAH FL
33012-5137
US

V. Phone/Fax

Practice location:
  • Phone: 786-773-4038
  • Fax:
Mailing address:
  • Phone: 786-773-4038
  • Fax: 786-773-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-384068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: