Healthcare Provider Details

I. General information

NPI: 1396241485
Provider Name (Legal Business Name): LILLIAN DIANNA SAHAGUN M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILLY D SAHAGUN M.ED

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 E 12TH ST
OAKLAND CA
94601-3424
US

IV. Provider business mailing address

3301 E 12TH ST STE 259
OAKLAND CA
94601-2940
US

V. Phone/Fax

Practice location:
  • Phone: 510-269-9030
  • Fax:
Mailing address:
  • Phone: 510-269-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: