Healthcare Provider Details

I. General information

NPI: 1619249877
Provider Name (Legal Business Name): MARLENE LLIBRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14361 LEANING PINE DR
MIAMI LAKES FL
33014-2516
US

IV. Provider business mailing address

14361 LEANING PINE DR
MIAMI LAKES FL
33014-2516
US

V. Phone/Fax

Practice location:
  • Phone: 305-586-0795
  • Fax:
Mailing address:
  • Phone: 305-586-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 11070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: