Provider Demographics
NPI:1447499793
Name:LIRIANO-FANDUIZ, HUMBERTO ANTONIO JR (MD)
Entity type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:ANTONIO
Last Name:LIRIANO-FANDUIZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HUMBERTO
Other - Middle Name:ANTONIO
Other - Last Name:LIRIANO
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5730 HAMLIN GROVES TRL STE 164
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5792
Mailing Address - Country:US
Mailing Address - Phone:407-347-7052
Mailing Address - Fax:321-282-6944
Practice Address - Street 1:5730 HAMLIN GROVES TRL STE 164
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5792
Practice Address - Country:US
Practice Address - Phone:407-347-7052
Practice Address - Fax:321-282-6944
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1126242080P0203X, 2080P0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine