=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316818446
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LILIAN CUBA CSFA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2025
-----------------------------------------------------
Last Update Date | 09/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3121 CITRON GOLD BLVD APT 220
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33559-7432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-724-2633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3121 CITRON GOLD BLVD APT 220
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33559-7432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-724-2633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZC0007X
-----------------------------------------------------
Taxonomy Name | Surgical Assistant
-----------------------------------------------------
License Number | 24476
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------