MEDICARE: LILLIAN RAE SILVA

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	103K00000X	Behavior Analyst		CA
2	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1447903075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN RAE SILVA

Provider Business Mailing Address
First Line	:	900 143RD AVE APT 74
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-3346
Country	:	US
Telephone Number	:	510-468-8994
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 143RD AVE APT 74
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-3346
Country	:	US
Telephone Number	:	510-468-8994
Fax Number	:

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

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	02/14/2022

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Directions to “ LILLIAN RAE SILVA ” Practice Location

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