Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 32503 | CA |
NPI | 1245666999 |
---|---|
Provider Name | Dr. Kerry L Lilley |
First Address | Kensington, CA 94706 |
Second Address | Kensington, CA 94706-1425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2013 |
Last Update Date | 25/09/2013 |