Provider Demographics
NPI:1790544781
Name:PENA ZAMORA, LIANIS
Entity Type:Individual
Prefix:
First Name:LIANIS
Middle Name:
Last Name:PENA ZAMORA
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 1:2857 39TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-1440
Mailing Address - Country:US
Mailing Address - Phone:239-544-6572
Mailing Address - Fax:
Practice Address - Street 1:2857 39TH AVE NE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-1440
Practice Address - Country:US
Practice Address - Phone:239-544-6572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician