MEDICARE: LILA ANA'S INTEGRATED WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1023572195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILA ANA'S INTEGRATED WELLNESS, LLC

Provider Business Mailing Address
First Line	:	9104 TOAST AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9104 TOAST AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4914
Country	:	US
Telephone Number	:	725-204-0402
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	LILA ANA'S INTEGRATED WELLNESS
Credential	:
Telephone Number	:	725-204-0402

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	01/23/2019

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