Provider Demographics
NPI:1760163869
Name:AHMED, LILLIAN MENA (BA)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MENA
Last Name:AHMED
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:LILLI
Other - Middle Name:
Other - Last Name:AHMED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:7023 E LA CUMBRE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4433
Mailing Address - Country:US
Mailing Address - Phone:626-991-2609
Mailing Address - Fax:
Practice Address - Street 1:7023 E LA CUMBRE DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-4433
Practice Address - Country:US
Practice Address - Phone:626-991-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician