Provider Demographics
NPI:1861753055
Name:PEREZ, LILIANA C
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:C
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 CROTON CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2039
Mailing Address - Country:US
Mailing Address - Phone:954-980-9449
Mailing Address - Fax:
Practice Address - Street 1:1331 CROTON CT
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-2039
Practice Address - Country:US
Practice Address - Phone:954-980-9449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003925600Medicaid