Provider Demographics
NPI:1386257228
Name:GONZALEZ, LILIANA ISABEL
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:ISABEL
Last Name:GONZALEZ
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 1:5360 N MESA ST STE A1
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5820
Mailing Address - Country:US
Mailing Address - Phone:915-613-2000
Mailing Address - Fax:915-613-4900
Practice Address - Street 1:5360 N MESA ST STE A1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5820
Practice Address - Country:US
Practice Address - Phone:915-613-2000
Practice Address - Fax:915-613-4900
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1337156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist