MEDICARE: DR. LILLIAN FILLPOT C.R.C

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	101YM0800X	Mental Health Counselor
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1598826794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILLIAN FILLPOT C.R.C

Provider Business Mailing Address
First Line	:	1171 HOMESTEAD RD STE 250
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-5485
Country	:	US
Telephone Number	:	559-285-0136
Fax Number	:

Provider Business Practice Location Address
First Line	:	1171 HOMESTEAD RD STE 250
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-5485
Country	:	US
Telephone Number	:	559-285-0136
Fax Number	:

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/31/2020

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Directions to “ DR. LILLIAN FILLPOT C.R.C” Practice Location

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