MEDICARE: MRS. RHIANNON ILUMIN

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	106H00000X	Marriage & Family Therapist	AMFT156757	CA

General Provider Information

NPI Number	:	1164277133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHIANNON ILUMIN

Provider Business Mailing Address
First Line	:	8327 OUTLOOK AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-4132
Country	:	US
Telephone Number	:	917-415-6752
Fax Number	:

Provider Business Practice Location Address
First Line	:	1382 BLUE OAKS BLVD
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-7019
Country	:	US
Telephone Number	:	877-412-8031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	11/30/2025

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Directions to “ MRS. RHIANNON ILUMIN ” Practice Location

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