Provider Demographics
NPI:1376930057
Name:GROEL, LIANA (MS, ATC)
Entity Type:Individual
Prefix:MISS
First Name:LIANA
Middle Name:
Last Name:GROEL
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RANCHO DEL ORO DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-8316
Mailing Address - Country:US
Mailing Address - Phone:760-901-8000
Mailing Address - Fax:760-721-7065
Practice Address - Street 1:400 RANCHO DEL ORO DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-8316
Practice Address - Country:US
Practice Address - Phone:760-901-8000
Practice Address - Fax:760-721-7065
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000002264OtherNATA BOC