Provider Demographics
NPI:1588867576
Name:CAMPOS-SACKLEY, LIANETTE (MD)
Entity type:Individual
Prefix:DR
First Name:LIANETTE
Middle Name:
Last Name:CAMPOS-SACKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10361 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7305
Mailing Address - Country:US
Mailing Address - Phone:305-772-4391
Mailing Address - Fax:305-444-0223
Practice Address - Street 1:814 PONCE DE LEON BLVD STE 510
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3035
Practice Address - Country:US
Practice Address - Phone:305-772-4391
Practice Address - Fax:305-444-0223
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine