Provider Demographics
NPI:1619417102
Name:MIAMI LICE LLC
Entity Type:Organization
Organization Name:MIAMI LICE LLC
Other - Org Name:LICE CLINICS OF AMERICA MIAMI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILSON O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-389-4430
Mailing Address - Street 1:1801 CORAL WAY
Mailing Address - Street 2:SUITE #320
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2790
Mailing Address - Country:US
Mailing Address - Phone:305-907-2121
Mailing Address - Fax:
Practice Address - Street 1:1801 CORAL WAY
Practice Address - Street 2:SUITE #320
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2790
Practice Address - Country:US
Practice Address - Phone:305-907-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty