Provider Demographics
NPI:1669020863
Name:HERNANDEZ QUIALA, LILLIANNE
Entity Type:Individual
Prefix:
First Name:LILLIANNE
Middle Name:
Last Name:HERNANDEZ QUIALA
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 1:24922 SW 118TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3311
Mailing Address - Country:US
Mailing Address - Phone:786-909-1524
Mailing Address - Fax:
Practice Address - Street 1:24922 SW 118TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-3311
Practice Address - Country:US
Practice Address - Phone:786-909-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-93534106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician