Provider Demographics
NPI:1144938168
Name:GOMEZ GARZA, LILIANA (PT, DPT)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:GOMEZ GARZA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LILI
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5757 VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3368
Mailing Address - Country:US
Mailing Address - Phone:760-275-3546
Mailing Address - Fax:
Practice Address - Street 1:10431 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-0110
Practice Address - Country:US
Practice Address - Phone:909-783-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2990832251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA299083OtherPHYSICAL THERAPY BOARD OF CALIFORNIA