Provider Demographics
NPI:1528656832
Name:GERARDO, LIANA RAQUEL (MS, ATC)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:RAQUEL
Last Name:GERARDO
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:LIANA
Other - Middle Name:RAQUEL
Other - Last Name:MARTIN-HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12500 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-3196
Mailing Address - Country:US
Mailing Address - Phone:510-436-2659
Mailing Address - Fax:
Practice Address - Street 1:12500 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-3196
Practice Address - Country:US
Practice Address - Phone:510-436-2659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer