MEDICARE: LILIANA COROMOTO ANDRADE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	M9126	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8CA588	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1285838870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIANA COROMOTO ANDRADE MD

Provider Business Mailing Address
First Line	:	2660 GULF FWY S
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-6820
Country	:	US
Telephone Number	:	832-505-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2660 GULF FWY S
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-6820
Country	:	US
Telephone Number	:	832-505-2100
Fax Number	:	281-337-0704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	12/06/2012

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