Healthcare Provider Details

I. General information

NPI: 1811206949
Provider Name (Legal Business Name): ANGELA LILLO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14668 N DEL WEBB BLVD
SUN CITY AZ
85351-2137
US

IV. Provider business mailing address

135 S STATE COLLEGE BLVD STE 350
BREA CA
92821-5814
US

V. Phone/Fax

Practice location:
  • Phone: 888-777-1945
  • Fax: 805-413-9099
Mailing address:
  • Phone: 888-777-1945
  • Fax: 805-413-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number247180
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: