Provider Demographics
NPI:1083401145
Name:HERRERA VILA, LIANNY
Entity type:Individual
Prefix:
First Name:LIANNY
Middle Name:
Last Name:HERRERA VILA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15131 SW 138TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5627
Mailing Address - Country:US
Mailing Address - Phone:786-399-2813
Mailing Address - Fax:
Practice Address - Street 1:15131 SW 138TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-5627
Practice Address - Country:US
Practice Address - Phone:786-399-2813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1241091106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician