Provider Demographics
NPI:1801658174
Name:HERRERA VAZQUEZ, LILIBET
Entity type:Individual
Prefix:
First Name:LILIBET
Middle Name:
Last Name:HERRERA VAZQUEZ
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 1:427 SE 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2742
Mailing Address - Country:US
Mailing Address - Phone:305-464-7396
Mailing Address - Fax:
Practice Address - Street 1:427 SE 24TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2742
Practice Address - Country:US
Practice Address - Phone:305-464-7396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician