Provider Demographics
NPI:1073183422
Name:ALVAREZ MESA, LILIANA
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:ALVAREZ MESA
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 1:333 S ROYAL POINCIANA BLVD APT 403
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6130
Mailing Address - Country:US
Mailing Address - Phone:305-546-4863
Mailing Address - Fax:
Practice Address - Street 1:101 WESTWARD DR
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5211
Practice Address - Country:US
Practice Address - Phone:305-885-1357
Practice Address - Fax:786-431-5691
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN259301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice