=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073011839
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ILANA SHARAUN M.F.T
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2018
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 288 QUINNHILL AVE
-----------------------------------------------------
City | LOS ALTOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-996-3362
-----------------------------------------------------
Fax | 650-949-3446
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 288 QUINNHILL AVE.
-----------------------------------------------------
City | LOS ALTOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-996-3362
-----------------------------------------------------
Fax | 650-949-3446
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 33483
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------