Healthcare Provider Details

I. General information

NPI: 1447499793
Provider Name (Legal Business Name): HUMBERTO ANTONIO LIRIANO-FANDUIZ JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HUMBERTO ANTONIO LIRIANO JR. MD

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 HAMLIN GROVES TRL STE 164
WINTER GARDEN FL
34787-5792
US

IV. Provider business mailing address

1206 BOWMAN ST
CLERMONT FL
34711-3144
US

V. Phone/Fax

Practice location:
  • Phone: 407-347-7052
  • Fax: 321-282-6944
Mailing address:
  • Phone: 407-347-7052
  • Fax: 321-295-7217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME112624
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME112624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: