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General NPI Number Information
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NPI Number | 1184386732
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Entity Type | Individual
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Provider Name | LILIANA ALEXANDRA MORENO SANTANDER
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Gender | Female
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 401 CARPENTER RD BLDG 525
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City | FORT MYER
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State | VA
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Zip | 22211-1009
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Country | US
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Telephone | 703-696-3460
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Fax |
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Provider Business Mailing Address
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Address Line | 226 COLBERT ST
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City | TANEYTOWN
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State | MD
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Zip | 21787-2615
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Country | US
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Telephone | 443-717-0512
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH22568
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License Number State | FL
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