Healthcare Provider Details

I. General information

NPI: 1750742227
Provider Name (Legal Business Name): LILIANA B LANDSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11476 S APOPKA VINELAND RD STE 118
ORLANDO FL
32836-7006
US

IV. Provider business mailing address

175 MIDDLE ST UNIT 1201
LAKE MARY FL
32746-3625
US

V. Phone/Fax

Practice location:
  • Phone: 407-955-4001
  • Fax: 407-745-0738
Mailing address:
  • Phone: 407-955-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-33850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: