Provider Demographics
NPI:1720467038
Name:PLASENCIA, LILIAN
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:PLASENCIA
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 1:14430 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6338
Mailing Address - Country:US
Mailing Address - Phone:305-781-1404
Mailing Address - Fax:305-552-9953
Practice Address - Street 1:9370 SUNSET DR STE A150
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5461
Practice Address - Country:US
Practice Address - Phone:786-322-2672
Practice Address - Fax:786-369-7054
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13261224Z00000X
FLOT18878225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA13261OtherLICENSE NO
FLOTR18878OtherLICENSE NUMBER