Provider Demographics
NPI:1265191423
Name:GALVEZ ALONSO, LILIANA (COTA)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:GALVEZ ALONSO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 SE 3RD ST APT 3207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-1752
Mailing Address - Country:US
Mailing Address - Phone:305-588-1654
Mailing Address - Fax:
Practice Address - Street 1:3481 NW 34TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5746
Practice Address - Country:US
Practice Address - Phone:786-553-3150
Practice Address - Fax:305-422-2422
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18193224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant