Provider Demographics
NPI:1104251636
Name:MESA, LILIANA (MED, BS)
Entity type:Individual
Prefix:MS
First Name:LILIANA
Middle Name:
Last Name:MESA
Suffix:
Gender:F
Credentials:MED, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 RACQUET CLUB RD
Mailing Address - Street 2:UNIT 36
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3420
Mailing Address - Country:US
Mailing Address - Phone:954-549-4050
Mailing Address - Fax:
Practice Address - Street 1:705 LE JEUNE RD
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4613
Practice Address - Country:US
Practice Address - Phone:305-883-5188
Practice Address - Fax:305-883-5183
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator