Provider Demographics
NPI:1447707534
Name:LIEDL, YAIRA
Entity type:Individual
Prefix:
First Name:YAIRA
Middle Name:
Last Name:LIEDL
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 1:8006 BEAVER CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-2435
Mailing Address - Country:US
Mailing Address - Phone:210-386-7276
Mailing Address - Fax:
Practice Address - Street 1:8006 BEAVER CREEK LOOP
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-2435
Practice Address - Country:US
Practice Address - Phone:210-386-7276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker