=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073913695
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LILLIANA OLIVIA CACHU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2014
-----------------------------------------------------
Last Update Date | 07/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4651 TELEPHONE RD STE 100
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-654-5570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5740 RALSTON ST STE 200
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93003-6009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-289-3383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 103654
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------