Provider Demographics
NPI:1285838870
Name:ANDRADE, LILIANA COROMOTO (MD)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:COROMOTO
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 GULF FWY S
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6820
Mailing Address - Country:US
Mailing Address - Phone:832-505-2100
Mailing Address - Fax:
Practice Address - Street 1:2660 GULF FWY S
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6820
Practice Address - Country:US
Practice Address - Phone:832-505-2100
Practice Address - Fax:281-337-0704
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9126207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CA588OtherBLUE CROSS BLUE SHIELD
TX8L13762Medicare PIN