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General NPI Number Information
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NPI Number | 1407460223
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Entity Type | Individual
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Provider Name | DAISY LOMADILLA BOYER
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Gender | Female
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 11703 HOLLY CREEK DR
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City | RIVERVIEW
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State | FL
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Zip | 33569-3356
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Country | US
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Telephone | 813-389-4118
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Fax |
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Provider Business Mailing Address
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Address Line | 11703 HOLLY CREEK DR
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City | RIVERVIEW
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State | FL
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Zip | 33569
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Country | US
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Telephone | 813-389-4118
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | L534-173-81-942-0
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State | FL
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