Provider Demographics
NPI:1174145155
Name:MONTANO GUERRA, LILIANNY DE LA C
Entity type:Individual
Prefix:
First Name:LILIANNY
Middle Name:DE LA C
Last Name:MONTANO GUERRA
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 1:2950 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5301
Mailing Address - Country:US
Mailing Address - Phone:786-506-1341
Mailing Address - Fax:
Practice Address - Street 1:2950 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5301
Practice Address - Country:US
Practice Address - Phone:786-506-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-117869106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106285300Medicaid