Healthcare Provider Details

I. General information

NPI: 1003935164
Provider Name (Legal Business Name): WILFRED LILJE CATC, R.R.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BILL LILJE C.A.T.C.

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SERRANIA AVE
WOODLAND HILLS CA
91364-3301
US

IV. Provider business mailing address

4900 SERRANIA AVE
WOODLAND HILLS CA
91364-3301
US

V. Phone/Fax

Practice location:
  • Phone: 818-347-1121
  • Fax: 818-347-0184
Mailing address:
  • Phone: 818-347-1577
  • Fax: 818-347-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number081794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: