Provider Demographics
NPI:1134839947
Name:FLORES PONS, LILIET
Entity type:Individual
Prefix:
First Name:LILIET
Middle Name:
Last Name:FLORES PONS
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 1:19200 NW 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2045
Mailing Address - Country:US
Mailing Address - Phone:786-546-3518
Mailing Address - Fax:
Practice Address - Street 1:19200 NW 51ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2045
Practice Address - Country:US
Practice Address - Phone:786-546-3518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty