Provider Demographics
NPI:1215780937
Name:LIU, BIANCA NADELIA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:NADELIA
Last Name:LIU
Suffix:
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 1:7510 SW 102ND ST # 105
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3135
Mailing Address - Country:US
Mailing Address - Phone:305-799-1050
Mailing Address - Fax:
Practice Address - Street 1:7510 SW 102ND ST # 105
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-3135
Practice Address - Country:US
Practice Address - Phone:305-799-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist