Provider Demographics
NPI:1629698394
Name:QUERO, LILIANA C
Entity Type:Individual
Prefix:MS
First Name:LILIANA
Middle Name:C
Last Name:QUERO
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 1:12271 LEXINGTON PARK DR APT 105
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2736
Mailing Address - Country:US
Mailing Address - Phone:813-317-0248
Mailing Address - Fax:
Practice Address - Street 1:12271 LEXINGTON PARK DR APT 105
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2736
Practice Address - Country:US
Practice Address - Phone:813-317-0248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLQ663523837240343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)