Provider Demographics
NPI:1487798575
Name:ILLESCAS, LILIANA (LMT)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:ILLESCAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 SW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4381
Mailing Address - Country:US
Mailing Address - Phone:305-528-8544
Mailing Address - Fax:305-448-3882
Practice Address - Street 1:14900 SW 43RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4381
Practice Address - Country:US
Practice Address - Phone:305-528-8544
Practice Address - Fax:305-448-3882
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 38750225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist