Healthcare Provider Details

I. General information

NPI: 1376991950
Provider Name (Legal Business Name): LIANET YATIM PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 03/08/2026
Certification Date: 03/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15972 SW 96TH TER
MIAMI FL
33196-6608
US

IV. Provider business mailing address

15972 SW 96TH TER
MIAMI FL
33196-6608
US

V. Phone/Fax

Practice location:
  • Phone: 786-270-7307
  • Fax:
Mailing address:
  • Phone: 786-270-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT22802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: