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General NPI Number Information
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NPI Number | 1164761359
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Entity Type | Organization
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Legal Business Name | LILIAN ODERA PHD LLC
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 7600 S RED RD SUITE 215
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5428
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Country | US
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Telephone | 305-608-6025
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Fax |
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Provider Business Mailing Address
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Address Line | 450 W PARK DR APT 104
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City | MIAMI
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State | FL
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Zip | 33172-3945
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Country | US
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Telephone | 305-608-6025
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. LILIAN ODERA
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Credential |
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Telephone | 305-608-6025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PY7889
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License Number State | FL
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