Healthcare Provider Details

I. General information

NPI: 1861176976
Provider Name (Legal Business Name): LILY EFUA BANKAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 KEARNEY ST
FREMONT CA
94538-2299
US

IV. Provider business mailing address

39650 LIBERTY ST STE 140
FREMONT CA
94538-2225
US

V. Phone/Fax

Practice location:
  • Phone: 650-565-8090
  • Fax:
Mailing address:
  • Phone: 510-498-3900
  • Fax: 510-498-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: