Healthcare Provider Details

I. General information

NPI: 1245178615
Provider Name (Legal Business Name): LILIANA SANGUINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46314 TIMINE WAY
PENDLETON OR
97801-9417
US

IV. Provider business mailing address

46314 TIMINE WAY
PENDLETON OR
97801-9417
US

V. Phone/Fax

Practice location:
  • Phone: 541-970-4011
  • Fax:
Mailing address:
  • Phone: 541-970-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number116254
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: