Provider Demographics
NPI:1194001016
Name:BAZAN, LILIA
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:
Last Name:BAZAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CAMINO DEL REMEDIO
Mailing Address - Street 2:ROOM257
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1332
Mailing Address - Country:US
Mailing Address - Phone:805-681-5136
Mailing Address - Fax:805-681-5517
Practice Address - Street 1:315 CAMINO DEL REMEDIO
Practice Address - Street 2:ROOM 257
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1332
Practice Address - Country:US
Practice Address - Phone:805-681-5136
Practice Address - Fax:805-681-5117
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health