Provider Demographics
NPI:1174316301
Name:PERDOMO VILLARREAL, LIANET
Entity type:Individual
Prefix:
First Name:LIANET
Middle Name:
Last Name:PERDOMO VILLARREAL
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 1:475 34TH AVENUE DR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-4455
Mailing Address - Country:US
Mailing Address - Phone:786-834-9014
Mailing Address - Fax:
Practice Address - Street 1:475 34TH AVENUE DR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-4455
Practice Address - Country:US
Practice Address - Phone:786-834-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty