Healthcare Provider Details

I. General information

NPI: 1396431045
Provider Name (Legal Business Name): MS. LILIANA MARIE APREZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 D ST
ANTIOCH CA
94509-2571
US

IV. Provider business mailing address

1524 GLAZIER DR APT 7
CONCORD CA
94521-1852
US

V. Phone/Fax

Practice location:
  • Phone: 925-754-3673
  • Fax:
Mailing address:
  • Phone: 909-850-2750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number16421-RAC
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16421-RAC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: