Provider Demographics
NPI:1083264790
Name:RANGEL, LILITH DEENA
Entity Type:Individual
Prefix:
First Name:LILITH
Middle Name:DEENA
Last Name:RANGEL
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 1:4826 VAN BUREN BLVD APT 304
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3259
Mailing Address - Country:US
Mailing Address - Phone:951-544-5339
Mailing Address - Fax:
Practice Address - Street 1:6840 INDIANA AVE STE 150
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4271
Practice Address - Country:US
Practice Address - Phone:951-530-8257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-14
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist