Provider Demographics
NPI:1841514973
Name:HEATH, LILIANA MILENA (DPM)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:MILENA
Last Name:HEATH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 EMBASSY DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4573
Mailing Address - Country:US
Mailing Address - Phone:954-443-4141
Mailing Address - Fax:954-431-7840
Practice Address - Street 1:2525 EMBASSY DR
Practice Address - Street 2:SUITE 4
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-4573
Practice Address - Country:US
Practice Address - Phone:954-443-4141
Practice Address - Fax:954-431-7840
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3485213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004677400Medicaid
FLGF460ZMedicare PIN