Healthcare Provider Details

I. General information

NPI: 1407168545
Provider Name (Legal Business Name): LILIA GONZALEZ-JOLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 MOWRY AVE STE 103
FREMONT CA
94538-1730
US

IV. Provider business mailing address

1860 MOWRY AVE STE 103
FREMONT CA
94538-1730
US

V. Phone/Fax

Practice location:
  • Phone: 510-249-9037
  • Fax: 510-249-9037
Mailing address:
  • Phone: 510-249-9037
  • Fax: 510-249-9037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number106107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: