Provider Demographics
NPI:1851053599
Name:LAREZ, LILIANA C
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:C
Last Name:LAREZ
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 1:4431 NW 112TH CT
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4389
Mailing Address - Country:US
Mailing Address - Phone:786-546-5328
Mailing Address - Fax:
Practice Address - Street 1:4431 NW 112TH CT
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4389
Practice Address - Country:US
Practice Address - Phone:786-546-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-67335106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician