Healthcare Provider Details

I. General information

NPI: 1467108811
Provider Name (Legal Business Name): LILIANA RENEE DAOEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 ROBERT AVE
WINTER HAVEN FL
33880-1437
US

IV. Provider business mailing address

403 ROBERT AVE
WINTER HAVEN FL
33880-1437
US

V. Phone/Fax

Practice location:
  • Phone: 863-409-7187
  • Fax:
Mailing address:
  • Phone: 863-409-7187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW18046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: