Healthcare Provider Details

I. General information

NPI: 1154553493
Provider Name (Legal Business Name): LILIANA LOPEZ-MORENO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12667 BISSONNET STREET
HOUSTON TX
77099
US

IV. Provider business mailing address

PO BOX 66308
HOUSTON TX
77266-6308
US

V. Phone/Fax

Practice location:
  • Phone: 832-548-5000
  • Fax:
Mailing address:
  • Phone: 832-548-5000
  • Fax: 713-559-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberP6450
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: