Healthcare Provider Details

I. General information

NPI: 1528985603
Provider Name (Legal Business Name): LILY MWANGI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 VILLA AVE
SAN JOSE CA
95126-2461
US

IV. Provider business mailing address

823 VILLA AVE
SAN JOSE CA
95126-2461
US

V. Phone/Fax

Practice location:
  • Phone: 510-363-5588
  • Fax:
Mailing address:
  • Phone: 510-363-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: