Provider Information for 1063124907
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ILIANA MARISOL LANDEROS M.Ed., LPC
Sex: Female
NPI: 1063124907
Last Updated: 2023-02-24
Certification Date: 2023-02-24
Certification Date: 2023-02-24
Details
| Name | Value | ||||||||
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| NPI | 1063124907 | ||||||||
| Enumeration Date | 2022-12-22 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 225 SANTOS RAMIREZ ST LA JOYA, TX 78560-4044 United States Phone: 956-467-6376 | Fax: | ||||||||
| Primary Practice Address | 1512 E GRIFFIN PKWY STE 8 MISSION, TX 78572-2416 United States Phone: 956-424-3433 | Fax: | ||||||||
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