Provider Demographics
NPI:1114176286
Name:LILIANNE SOBRADO M D P A
Entity Type:Organization
Organization Name:LILIANNE SOBRADO M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBRADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-270-0402
Mailing Address - Street 1:8525 SW 92ND ST
Mailing Address - Street 2:SUITE D 17
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7365
Mailing Address - Country:US
Mailing Address - Phone:305-270-0402
Mailing Address - Fax:305-595-6179
Practice Address - Street 1:8525 SW 92ND ST
Practice Address - Street 2:SUITE D 17
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7365
Practice Address - Country:US
Practice Address - Phone:305-270-0402
Practice Address - Fax:305-595-6179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056370261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256035600Medicaid
FLE66534Medicare UPIN
FL256035600Medicaid