Healthcare Provider Details

I. General information

NPI: 1679925226
Provider Name (Legal Business Name): LUCIANA TILLOTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 TEXAS ST STE 203
SAN DIEGO CA
92108-3723
US

IV. Provider business mailing address

5005 TEXAS ST STE 203
SAN DIEGO CA
92108-3723
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-0727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: