Provider Demographics
NPI:1982171450
Name:REYES, LILLIANA V
Entity Type:Individual
Prefix:
First Name:LILLIANA
Middle Name:V
Last Name:REYES
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 1:3004 PARKWAY BLVD APT 303
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4506
Mailing Address - Country:US
Mailing Address - Phone:939-250-9761
Mailing Address - Fax:
Practice Address - Street 1:3004 PARKWAY BLVD APT 303
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-4506
Practice Address - Country:US
Practice Address - Phone:939-250-9761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR214538935890OtherDRIVERS LICENSE