Provider Demographics
NPI:1467647669
Name:ESPINOZA, LILIANA (PA)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 YORK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2052
Mailing Address - Country:US
Mailing Address - Phone:972-296-5557
Mailing Address - Fax:972-296-5592
Practice Address - Street 1:951 YORK DR STE 102
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2052
Practice Address - Country:US
Practice Address - Phone:972-296-5557
Practice Address - Fax:972-296-5592
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05360363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K0435Medicare PIN