Healthcare Provider Details

I. General information

NPI: 1346066008
Provider Name (Legal Business Name): LILIANA VIGOA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 SW 134TH PL APT 203
MIAMI FL
33177-1188
US

IV. Provider business mailing address

15300 SW 134TH PL APT 203
MIAMI FL
33177-1188
US

V. Phone/Fax

Practice location:
  • Phone: 786-627-3542
  • Fax:
Mailing address:
  • Phone: 786-627-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-388333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: