Provider Demographics
NPI:1437839545
Name:DZIDULA, LILY ELIKPLIM
Entity Type:Individual
Prefix:MS
First Name:LILY
Middle Name:ELIKPLIM
Last Name:DZIDULA
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 1:859 N MOUNTAIN AVE APT 27A
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4123
Mailing Address - Country:US
Mailing Address - Phone:840-900-6430
Mailing Address - Fax:
Practice Address - Street 1:859 N MOUNTAIN AVE APT 27A
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4123
Practice Address - Country:US
Practice Address - Phone:840-900-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker