Healthcare Provider Details

I. General information

NPI: 1780160978
Provider Name (Legal Business Name): LYLA BELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 BANCROFT AVE
SAN LEANDRO CA
94577-6107
US

IV. Provider business mailing address

3691 SWALLOW CT
CASTRO VALLEY CA
94546-3060
US

V. Phone/Fax

Practice location:
  • Phone: 510-618-4400
  • Fax:
Mailing address:
  • Phone: 925-209-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number170261086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: