Provider Demographics
NPI:1972168227
Name:MACHADO, LILIAM R
Entity Type:Individual
Prefix:
First Name:LILIAM
Middle Name:R
Last Name:MACHADO
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 1:305 W 68TH ST APT 420
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5407
Mailing Address - Country:US
Mailing Address - Phone:786-371-9415
Mailing Address - Fax:
Practice Address - Street 1:10550 NW 77TH CT STE 313-314
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-7084
Practice Address - Country:US
Practice Address - Phone:305-825-4320
Practice Address - Fax:305-825-8117
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator