Healthcare Provider Details

I. General information

NPI: 1306764691
Provider Name (Legal Business Name): LILIAN CANLAS SACUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1820 BETHANY AVE
SAN JOSE CA
95132-1514
US

IV. Provider business mailing address

14 WESTLINE DR
DALY CITY CA
94015-4735
US

V. Phone/Fax

Practice location:
  • Phone: 408-649-6532
  • Fax:
Mailing address:
  • Phone: 408-649-6532
  • Fax: 408-649-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number435202674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: