Provider Demographics
NPI:1619376035
Name:MAMPOSO, LIANET (MD)
Entity Type:Individual
Prefix:
First Name:LIANET
Middle Name:
Last Name:MAMPOSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIANET
Other - Middle Name:
Other - Last Name:MAMPOSO PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14223 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6408
Mailing Address - Country:US
Mailing Address - Phone:786-845-5600
Mailing Address - Fax:786-363-8157
Practice Address - Street 1:14223 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6408
Practice Address - Country:US
Practice Address - Phone:786-845-5600
Practice Address - Fax:786-363-8157
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127379208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018073600Medicaid