Healthcare Provider Details

I. General information

NPI: 1083813620
Provider Name (Legal Business Name): LILLI ANN C CELLONA M D A MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8245 E MONTE VISTA RD SUITE 200
ANAHEIM CA
92808-1295
US

IV. Provider business mailing address

8245 E MONTE VISTA RD SUITE 200
ANAHEIM CA
92808-1295
US

V. Phone/Fax

Practice location:
  • Phone: 714-974-0100
  • Fax: 714-974-0300
Mailing address:
  • Phone: 714-974-0100
  • Fax: 714-974-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA052283
License Number StateCA

VIII. Authorized Official

Name: ELIZABETH ALCARAZ
Title or Position: BILLING MANAGER
Credential:
Phone: 714-974-0100