Provider Demographics
NPI:1497083356
Name:AVANTO, LILIANA MARIA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:LILIANA
Middle Name:MARIA
Last Name:AVANTO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 WATSON ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022
Mailing Address - Country:US
Mailing Address - Phone:253-221-7312
Mailing Address - Fax:253-862-6254
Practice Address - Street 1:853 WATSON ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022
Practice Address - Country:US
Practice Address - Phone:253-221-7312
Practice Address - Fax:253-221-7312
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA6093380225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist