Basic Information
| Provider Information | |||||||||
| NPI: | 1548290307 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURILLO | ||||||||
| FirstName: | LORENA | ||||||||
| MiddleName: | AIDE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN-CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13001 EASTLAKE BLVD STE 114 | ||||||||
| Address2: | |||||||||
| City: | HORIZON CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799286312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155914624 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13001 EASTLAKE BLVD STE 114 | ||||||||
| Address2: | |||||||||
| City: | HORIZON CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799286312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155914624 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 599995 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.