Provider Demographics
NPI:1992904262
Name:MANZANO, LILIANA C (LSA)
Entity type:Individual
Prefix:MRS
First Name:LILIANA
Middle Name:C
Last Name:MANZANO
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 DURHAM CHASE LANE
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4739
Mailing Address - Country:US
Mailing Address - Phone:832-392-1747
Mailing Address - Fax:
Practice Address - Street 1:2718 DURHAM CHASE LANE
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4739
Practice Address - Country:US
Practice Address - Phone:281-829-5417
Practice Address - Fax:713-627-1217
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00301246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y2286OtherBLUE CROSS BLUE SHIELD