Healthcare Provider Details

I. General information

NPI: 1033711650
Provider Name (Legal Business Name): LILLIAN RAIN RIFE M.ED., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 CROW CANYON PLACE SUITE 100
SAN RAMON CA
94583-1344
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-53212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: