Provider Demographics
NPI:1790394013
Name:LIMA, CLEO MILAGRO
Entity Type:Individual
Prefix:
First Name:CLEO
Middle Name:MILAGRO
Last Name:LIMA
Suffix:
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 1:3101 W ADAMS AVE APT 259
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-2846
Mailing Address - Country:US
Mailing Address - Phone:773-206-0229
Mailing Address - Fax:
Practice Address - Street 1:3101 W ADAMS AVE APT 259
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-2846
Practice Address - Country:US
Practice Address - Phone:773-206-0229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343677164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse