Healthcare Provider Details

I. General information

NPI: 1740123645
Provider Name (Legal Business Name): LILIANA THOUSAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N 12TH ST
RICHMOND VA
23298-5009
US

IV. Provider business mailing address

12 S 19TH ST APT 201
RICHMOND VA
23223-7590
US

V. Phone/Fax

Practice location:
  • Phone: 336-580-4522
  • 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 Number0203021422
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: