Basic Information
Provider Information
NPI: 1457025603
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILL
FirstName: LILIA
MiddleName: GARZA
NamePrefix:  
NameSuffix:  
Credential: FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 26666
Address2: PROVIDER ENROLLMENT
City: ALBUQUERQUE
State: NM
PostalCode: 871256666
CountryCode: US
TelephoneNumber: 5059236770
FaxNumber:  
Practice Location
Address1: 401 SAN MATEO BLVD SE
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871082921
CountryCode: US
TelephoneNumber: 5054627333
FaxNumber: 5054627301
Other Information
ProviderEnumerationDate: 08/02/2021
LastUpdateDate: 08/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X64351NMY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home