Provider Demographics
NPI:1417589193
Name:SANDOVAL, LILIANA (LVN)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7370 PHIL HANSEN DR
Mailing Address - Street 2:
Mailing Address - City:CANUTILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79835-6480
Mailing Address - Country:US
Mailing Address - Phone:915-760-3505
Mailing Address - Fax:
Practice Address - Street 1:7370 PHIL HANSEN DR
Practice Address - Street 2:
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835-6480
Practice Address - Country:US
Practice Address - Phone:915-760-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351327164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse