Healthcare Provider Details

I. General information

NPI: 1992117766
Provider Name (Legal Business Name): LILIANA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8686 CORAL WAY
MIAMI FL
33155-2338
US

IV. Provider business mailing address

10401 SW 40TH ST
MIAMI FL
33165-3745
US

V. Phone/Fax

Practice location:
  • Phone: 305-269-2550
  • Fax: 305-269-2546
Mailing address:
  • Phone: 305-222-2000
  • Fax: 305-553-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN9299617
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: