Provider Demographics
NPI:1083694434
Name:DE LA HOZ-AYARZA, LILIANA M (PT)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:M
Last Name:DE LA HOZ-AYARZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001A ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7938
Mailing Address - Country:US
Mailing Address - Phone:718-205-4911
Mailing Address - Fax:718-205-5946
Practice Address - Street 1:9001A ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7938
Practice Address - Country:US
Practice Address - Phone:718-205-4911
Practice Address - Fax:718-205-5946
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02459869Medicaid
NY02459869Medicaid
NY05992Medicare PIN