Provider Demographics
NPI:1003304742
Name:LLITERAS, MAICELYS
Entity Type:Individual
Prefix:
First Name:MAICELYS
Middle Name:
Last Name:LLITERAS
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 1:1000 SW 78TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4202
Mailing Address - Country:US
Mailing Address - Phone:305-300-9759
Mailing Address - Fax:
Practice Address - Street 1:1000 SW 78TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4202
Practice Address - Country:US
Practice Address - Phone:305-300-9759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023401800Medicaid