Provider Demographics
NPI:1679836555
Name:ALIAGA DEZA, LORENA (MD)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:ALIAGA DEZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:305-387-7211
Mailing Address - Fax:305-382-2708
Practice Address - Street 1:13734 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6020
Practice Address - Country:US
Practice Address - Phone:305-387-7211
Practice Address - Fax:305-382-2708
Is Sole Proprietor?:No
Enumeration Date:2012-06-16
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3473208000000X
FLME149906208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111348900Medicaid