Healthcare Provider Details

I. General information

NPI: 1477900074
Provider Name (Legal Business Name): LIDICE ZURBANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 NW 107TH AVE STE 301
SWEETWATER FL
33172-2742
US

IV. Provider business mailing address

14225 SW 176TH TER
MIAMI FL
33177-2612
US

V. Phone/Fax

Practice location:
  • Phone: 786-860-5161
  • Fax: 813-762-2901
Mailing address:
  • Phone: 786-691-0457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: