MEDICARE: LILLIAN CALO

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1780431478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN CALO

Provider Business Mailing Address
First Line	:	7303 SHOUP AVE
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91307-1737
Country	:	US
Telephone Number	:	973-598-5624
Fax Number	:

Provider Business Practice Location Address
First Line	:	7303 SHOUP AVE
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91307-1737
Country	:	US
Telephone Number	:	973-598-5624
Fax Number	:

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

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	05/01/2024

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Directions to “ LILLIAN CALO ” Practice Location

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