Provider Demographics
NPI:1841716347
Name:CARRERO, LILIANA
Entity type:Individual
Prefix:MRS
First Name:LILIANA
Middle Name:
Last Name:CARRERO
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 1:1422 E MOWRY DR APT 108
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4949
Mailing Address - Country:US
Mailing Address - Phone:786-728-1286
Mailing Address - Fax:
Practice Address - Street 1:756 W PALM DR
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-3224
Practice Address - Country:US
Practice Address - Phone:305-246-3530
Practice Address - Fax:305-246-4686
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL247200000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL590839562Medicaid