MEDICARE: MS. LILIANA GORDON

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1609524602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LILIANA GORDON

Provider Business Mailing Address
First Line	:	1220 12TH AVE SE UNIT 1204
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73071-2555
Country	:	US
Telephone Number	:	405-464-9210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 N CLASSEN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6611
Country	:	US
Telephone Number	:	405-235-5671
Fax Number	:

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

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	03/17/2022

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