Provider Demographics
NPI:1801965066
Name:HEVIA, LIZA MARIE (PROVISIONAL)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:MARIE
Last Name:HEVIA
Suffix:
Gender:F
Credentials:PROVISIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8802 NW 178TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6546
Mailing Address - Country:US
Mailing Address - Phone:305-820-9159
Mailing Address - Fax:
Practice Address - Street 1:11005 SW 186TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6810
Practice Address - Country:US
Practice Address - Phone:305-378-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 4792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist