MEDICARE: MRS. LILA KHALILI LCSW

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	1041C0700X	Clinical Social Worker	LCS21648	CA

General Provider Information

NPI Number	:	1609815455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILA KHALILI LCSW

Provider Business Mailing Address
First Line	:	142 N AVENIDA BARCA
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-2305
Country	:	US
Telephone Number	:	714-624-0651
Fax Number	:	714-998-2941

Provider Business Practice Location Address
First Line	:	33 CREEK RD
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-7707
Country	:	US
Telephone Number	:	714-624-0651
Fax Number	:	714-998-2941

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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