Provider Demographics
NPI:1669990537
Name:GAMINO, LILIANA (NP-C)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:GAMINO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 OLD MCGREGOR RD
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6499
Mailing Address - Country:US
Mailing Address - Phone:254-307-3997
Mailing Address - Fax:254-300-9935
Practice Address - Street 1:100 HILLCREST MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8897
Practice Address - Country:US
Practice Address - Phone:254-202-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2024-12-18
Deactivation Date:2017-12-06
Deactivation Code:
Reactivation Date:2017-12-27
Provider Licenses
StateLicense IDTaxonomies
TXF08171236363L00000X
TXAP135167363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner