Healthcare Provider Details

I. General information

NPI: 1245169036
Provider Name (Legal Business Name): LILIANA PRATA SOUZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARECHAL CAMPOS AV, 1355 SANTA CECILIA
VITORIA ES
29043260
BR

IV. Provider business mailing address

EARIJOS, 61 APT 301, JARDIM DA PENHA
VITORIA ES
29060700
BR

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: