Healthcare Provider Details

I. General information

NPI: 1619189172
Provider Name (Legal Business Name): MICHELLE S. CILIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 17TH ST
SAN FRANCISCO CA
94103-5012
US

IV. Provider business mailing address

310 ARKANSAS ST
SAN FRANCISCO CA
94107-2846
US

V. Phone/Fax

Practice location:
  • Phone: 415-710-6731
  • Fax:
Mailing address:
  • Phone: 415-710-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number68705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: