1780479279 NPI number — LILIAN MILURGIA LEAL VELAZQUEZ

Table of content: LILIAN MILURGIA LEAL VELAZQUEZ (NPI 1780479279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780479279 NPI number — LILIAN MILURGIA LEAL VELAZQUEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEAL VELAZQUEZ
Provider First Name:
LILIAN
Provider Middle Name:
MILURGIA
Provider Name Prefix Text:
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:
1780479279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15280 SW 308TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMESTEAD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33033-4361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-801-2782
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15280 SW 308TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMESTEAD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33033-4361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-801-2782
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2025

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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