Provider Demographics
NPI:1184211526
Name:SANDOVAL, LILIANA LOPEZ (FNP-C)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:LOPEZ
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5562 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2466
Mailing Address - Country:US
Mailing Address - Phone:214-868-4371
Mailing Address - Fax:
Practice Address - Street 1:1131 W 6TH ST STE 305
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1121
Practice Address - Country:US
Practice Address - Phone:713-589-5283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95016122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily