Provider Demographics
NPI:1992795942
Name:REGUERO, LILLIAN (MD)
Entity type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:
Last Name:REGUERO
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 1:3431 S. ORANGE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8508
Mailing Address - Country:US
Mailing Address - Phone:407-422-8873
Mailing Address - Fax:407-425-4294
Practice Address - Street 1:3431 S. ORANGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8508
Practice Address - Country:US
Practice Address - Phone:407-422-8873
Practice Address - Fax:407-425-4294
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00436802080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55114Medicare UPIN
FL47603Medicare ID - Type Unspecified