Provider Demographics
NPI:1508512633
Name:PEREZ QUINTANA, LIANEC (HHA)
Entity Type:Individual
Prefix:
First Name:LIANEC
Middle Name:
Last Name:PEREZ QUINTANA
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 W RAMBLA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7535
Mailing Address - Country:US
Mailing Address - Phone:813-516-4382
Mailing Address - Fax:
Practice Address - Street 1:2104 W RAMBLA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7535
Practice Address - Country:US
Practice Address - Phone:813-516-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112828100Medicaid