Provider Demographics
NPI:1285081240
Name:ARMIJO, LIANA
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:ARMIJO
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 1:3564 AL ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2764
Mailing Address - Country:US
Mailing Address - Phone:915-252-2608
Mailing Address - Fax:
Practice Address - Street 1:3564 AL ROBERTS DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-2764
Practice Address - Country:US
Practice Address - Phone:915-252-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3087390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT3087OtherATHLETIC TRAINER
TX2000011268OtherATHLETIC TRAINER