1164249512 NPI number — MISS LILLIAN DAILI FERREIRA OQUENDO

Table of content: MISS LILLIAN DAILI FERREIRA OQUENDO (NPI 1164249512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164249512 NPI number — MISS LILLIAN DAILI FERREIRA OQUENDO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERREIRA OQUENDO
Provider First Name:
LILLIAN
Provider Middle Name:
DAILI
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164249512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4422 SKYLINE BLVD
Provider Second Line Business Mailing Address:
APT 106
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-228-0940
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4422 SKYLINE BLVD
Provider Second Line Business Practice Location Address:
APT 106
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-228-0940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2024

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: 106S00000X , with the licence number:  BACB894149 , 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)





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