Provider Demographics
NPI:1376042200
Name:MCBROOM, LILIANA I
Entity Type:Individual
Prefix:MISS
First Name:LILIANA
Middle Name:
Last Name:MCBROOM
Suffix:I
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 1:1280 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-9711
Mailing Address - Country:US
Mailing Address - Phone:619-871-4736
Mailing Address - Fax:
Practice Address - Street 1:1280 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-9711
Practice Address - Country:US
Practice Address - Phone:619-871-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUM948551374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide