Healthcare Provider Details

I. General information

NPI: 1427795467
Provider Name (Legal Business Name): LILIA CORAL REQUENA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17448 HIGHWAY 3 FL 2
WEBSTER TX
77598-4197
US

IV. Provider business mailing address

5402 AIRLINE DR
HOUSTON TX
77076-4902
US

V. Phone/Fax

Practice location:
  • Phone: 832-505-1748
  • Fax:
Mailing address:
  • Phone: 713-239-1572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1077259
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1077259
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: