Individual
VILAIRE LIZIMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7525 DRAGON FLY LOOP, GIBSONTON, FL 33534-5648
(954) 213-4855
Mailing address
7525 DRAGON FLY LOOP, GIBSONTON, FL 33534-5648
(954) 213-4855
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
744398
—
FL
Enumeration date
03/13/2019
Last updated
03/13/2019
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