Provider Demographics
NPI:1639302144
Name:MORALES SANTOS, LILLIANA
Entity Type:Individual
Prefix:
First Name:LILLIANA
Middle Name:
Last Name:MORALES SANTOS
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 1:9160 SW 153RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2853
Mailing Address - Country:US
Mailing Address - Phone:787-598-1339
Mailing Address - Fax:
Practice Address - Street 1:13590 SW 134TH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4561
Practice Address - Country:US
Practice Address - Phone:786-732-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7150235Z00000X
PR901235Z00000X
FLSA 15040235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015277000Medicaid