Healthcare Provider Details

I. General information

NPI: 1265323455
Provider Name (Legal Business Name): LIANIS DEL VALLE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10381 SW 156TH ST
MIAMI FL
33157-1549
US

IV. Provider business mailing address

10381 SW 156TH ST
MIAMI FL
33157-1549
US

V. Phone/Fax

Practice location:
  • Phone: 786-928-8945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11042860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: