Healthcare Provider Details

I. General information

NPI: 1285838870
Provider Name (Legal Business Name): LILIANA COROMOTO ANDRADE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 GULF FWY S
LEAGUE CITY TX
77573-6820
US

IV. Provider business mailing address

2660 GULF FWY S
LEAGUE CITY TX
77573-6820
US

V. Phone/Fax

Practice location:
  • Phone: 832-505-2100
  • Fax: 281-337-0704
Mailing address:
  • Phone: 832-505-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberM9126
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: