Provider Demographics
NPI:1437892361
Name:RESTO, ILIANA (BS)
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:
Last Name:RESTO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:ILANA
Other - Middle Name:
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:651 W WARREN AVE # 100
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4036
Mailing Address - Country:US
Mailing Address - Phone:407-214-9019
Mailing Address - Fax:
Practice Address - Street 1:651 W WARREN AVE # 100
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4036
Practice Address - Country:US
Practice Address - Phone:407-214-9019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor