Healthcare Provider Details

I. General information

NPI: 1093013252
Provider Name (Legal Business Name): LILIAN BELINDA RUANO CEBALLOS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 SW 113TH PL
MIAMI FL
33165-3416
US

IV. Provider business mailing address

3530 SW 113TH PL
MIAMI FL
33165-3416
US

V. Phone/Fax

Practice location:
  • Phone: 786-217-7773
  • Fax:
Mailing address:
  • Phone: 786-217-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11007986
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: