Provider Demographics
NPI:1154880342
Name:HERNANDEZ, LILLIANA LYNETTE
Entity type:Individual
Prefix:
First Name:LILLIANA
Middle Name:LYNETTE
Last Name:HERNANDEZ
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 1:6511 W LOOP 1604 N STE 117
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5440
Mailing Address - Country:US
Mailing Address - Phone:210-201-0185
Mailing Address - Fax:210-688-9228
Practice Address - Street 1:6511 W LOOP 1604 N STE 117
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5440
Practice Address - Country:US
Practice Address - Phone:210-201-0185
Practice Address - Fax:210-688-9228
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1316302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist