Provider Demographics
NPI:1366717340
Name:LIBERMAN, INNA (PA)
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:LIBERMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11880 SW 40TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-223-8808
Mailing Address - Fax:305-223-8974
Practice Address - Street 1:9035 SUNSET DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3484
Practice Address - Country:US
Practice Address - Phone:305-279-3366
Practice Address - Fax:305-271-3355
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9106453207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGF433YOtherMEDICARE
FLGF433ZOtherMEDICARE