Provider Demographics
NPI:1508373283
Name:CRESPO, LILIANA TAYAMI
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:TAYAMI
Last Name:CRESPO
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 1:3240 SW 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3411
Mailing Address - Country:US
Mailing Address - Phone:786-365-9384
Mailing Address - Fax:
Practice Address - Street 1:3240 SW 80TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3411
Practice Address - Country:US
Practice Address - Phone:786-365-9384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician