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General NPI Number Information
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NPI Number | 1912787334
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Entity Type | Organization
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Legal Business Name | JILLA LAVIAN
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 800 AIRPORT BLVD STE 402
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City | BURLINGAME
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State | CA
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Zip | 94010-1929
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Country | US
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Telephone | 650-799-5543
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 LAKEVIEW DR
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City | HILLSBOROUGH
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State | CA
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Zip | 94010-7325
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ LCSW
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Name | JILLA LAVIAN
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Credential |
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Telephone | 650-799-5543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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