Healthcare Provider Details

I. General information

NPI: 1396250262
Provider Name (Legal Business Name): LILY KUIPERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 PICO BLVD
SANTA MONICA CA
90405-1326
US

IV. Provider business mailing address

2627 HIGHLAND AVE APT 2
SANTA MONICA CA
90405-4454
US

V. Phone/Fax

Practice location:
  • Phone: 866-452-5273
  • Fax:
Mailing address:
  • Phone: 310-279-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: