Provider Demographics
NPI:1194404970
Name:MARTIN MONTES DE OCA, LILIANA SR
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:MARTIN MONTES DE OCA
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 NW 36TH ST APT 313
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5013
Mailing Address - Country:US
Mailing Address - Phone:786-236-6995
Mailing Address - Fax:
Practice Address - Street 1:3530 NW 36TH ST APT 313
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5013
Practice Address - Country:US
Practice Address - Phone:786-236-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-271231106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty