1447499793 NPI number — DR. HUMBERTO ANTONIO LIRIANO-FANDUIZ JR. M.D.

Table of content: DR. HUMBERTO ANTONIO LIRIANO-FANDUIZ JR. M.D. (NPI 1447499793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447499793 NPI number — DR. HUMBERTO ANTONIO LIRIANO-FANDUIZ JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIRIANO-FANDUIZ
Provider First Name:
HUMBERTO
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIRIANO
Provider Other First Name:
HUMBERTO
Provider Other Middle Name:
ANTONIO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447499793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5730 HAMLIN GROVES TRL STE 164
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER GARDEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34787-5792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-347-7052
Provider Business Mailing Address Fax Number:
321-282-6944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5730 HAMLIN GROVES TRL STE 164
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER GARDEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34787-5792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-347-7052
Provider Business Practice Location Address Fax Number:
321-282-6944
Provider Enumeration Date:
02/10/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0203X , with the licence number:  ME112624 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0204X , with the licence number: ME112624 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME112624 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)