Provider Demographics
NPI:1063834745
Name:BRUDASCA, LILIANA MARIA
Entity Type:Individual
Prefix:MRS
First Name:LILIANA
Middle Name:MARIA
Last Name:BRUDASCA
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 1:840 SW 118TH TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3828
Mailing Address - Country:US
Mailing Address - Phone:954-907-8667
Mailing Address - Fax:
Practice Address - Street 1:4699 N STATE ROAD 7 STE P&Z
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5879
Practice Address - Country:US
Practice Address - Phone:954-234-2724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9257526163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse