Provider Demographics
NPI:1700511938
Name:HERRERA PEREIRA, LIETTY GABRIELA (HHA)
Entity Type:Individual
Prefix:
First Name:LIETTY
Middle Name:GABRIELA
Last Name:HERRERA PEREIRA
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16480 SW 304TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3276
Mailing Address - Country:US
Mailing Address - Phone:305-803-6298
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 79TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1003
Practice Address - Country:US
Practice Address - Phone:786-409-2796
Practice Address - Fax:786-464-0976
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5024638374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL215415788424OtherAMERICAN HEART ASSOCIATION