Healthcare Provider Details

I. General information

NPI: 1619376035
Provider Name (Legal Business Name): LIANET MAMPOSO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIANET MAMPOSO PEREZ MD

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14223 SW 42ND ST
MIAMI FL
33175-6408
US

IV. Provider business mailing address

14223 SW 42ND ST
MIAMI FL
33175-6408
US

V. Phone/Fax

Practice location:
  • Phone: 786-845-5600
  • Fax: 786-363-8157
Mailing address:
  • Phone: 786-845-5600
  • Fax: 786-363-8157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME127379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: