Healthcare Provider Details

I. General information

NPI: 1093401234
Provider Name (Legal Business Name): LIZETH T JAIMES SERRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9487 SW 76TH ST APT M7
MIAMI FL
33173-3369
US

IV. Provider business mailing address

9487 SW 76TH ST APT M7
MIAMI FL
33173-3369
US

V. Phone/Fax

Practice location:
  • Phone: 786-389-6329
  • Fax:
Mailing address:
  • Phone: 786-389-6329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-257524
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number8438
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: