Provider Demographics
NPI:1053329029
Name:GUADRON-HERNANDEZ, LILIANA E (PA)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:E
Last Name:GUADRON-HERNANDEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38209 47TH ST E STE C
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-3113
Mailing Address - Country:US
Mailing Address - Phone:661-951-3100
Mailing Address - Fax:661-951-3195
Practice Address - Street 1:38209 47TH ST E STE C
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-3113
Practice Address - Country:US
Practice Address - Phone:661-951-3100
Practice Address - Fax:661-951-3195
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16240363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACU312VMedicare PIN
P926664Medicare UPIN