Provider Demographics
NPI:1629213467
Name:RUEDA, LILIANA PATRICIA
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:PATRICIA
Last Name:RUEDA
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 1:17151 NW 87TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6676
Mailing Address - Country:US
Mailing Address - Phone:305-546-9256
Mailing Address - Fax:772-248-1114
Practice Address - Street 1:15056 SW 113TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2594
Practice Address - Country:US
Practice Address - Phone:305-546-9256
Practice Address - Fax:772-248-1114
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12662235Z00000X
FLSI10482355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant