Provider Demographics
NPI:1760076566
Name:GUERRA, LIETTYS
Entity Type:Individual
Prefix:
First Name:LIETTYS
Middle Name:
Last Name:GUERRA
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 1:12485 SW 137TH AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4215
Mailing Address - Country:US
Mailing Address - Phone:786-592-2748
Mailing Address - Fax:
Practice Address - Street 1:12485 SW 137TH AVE STE 109
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4215
Practice Address - Country:US
Practice Address - Phone:786-592-2748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator