Healthcare Provider Details

I. General information

NPI: 1093503922
Provider Name (Legal Business Name): LILIAN MBUTHIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PROMENADE CIR
SACRAMENTO CA
95834-2939
US

IV. Provider business mailing address

180 PROMENADE CIR
SACRAMENTO CA
95834-2939
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: