Healthcare Provider Details

I. General information

NPI: 1639002843
Provider Name (Legal Business Name): LILY FLOWER OF THE VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2648 INTERNATIONAL BLVD STE 402
OAKLAND CA
94601-1580
US

IV. Provider business mailing address

2648 INTERNATIONAL BLVD STE 402
OAKLAND CA
94601-1580
US

V. Phone/Fax

Practice location:
  • Phone: 510-479-3037
  • Fax:
Mailing address:
  • Phone: 510-479-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR H MUDENDA
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD, MBA
Phone: 510-479-3037